Reviewer’s report
Title: 
The New American Joint Committee on Cancer T Staging System for
Stomach: Increased Complexity without Clear Improvement in Predictive
Accuracy for Endoscopic Ultrasound
Version: 
1 
Date: 
02 Jun 2020
Reviewer's report:
The authors presented a retrospective analysis of clinical and EUS imaging
features of 348 patients with gastric cancer who underwent radical resection
comparing preoperative staging by EUS using either the 6th, 7th or 8th edition of
TNM.
Introduction
1) I do not understand the expression "monotonicity of gradients"
2) Please revise English expression throughout the text
Methods
3) Line 16, please amend as "…they underwent pre-operative staging by EUS"
4) Line 38, maybe you mean that both linear and radial echoendoscopes were
used? Please specify. Amend "heteroscope"
5) Please explain how was the restaging performed. Based on videos? Still
images? Report? Who performed the restaging? How was consensus reached in
case of disagreement? 
Results
6) Please explain which classification was used during the exam, in real time.
6th, 7th or 8th? If different classifications were used according to the different
time periods of enrollment, please specify how many patients were enrolled
according to the classification used in real time.
7) Instead of "EUS type" please use "echoendoscope type"
8) Page 7, line 21, please amend as "…EUS accuracy was not influenced by the
size of the gastric lesion or presence of ascites."
9) Line 29, please use "angulus" instead of "angle"
Discussion
10) Line 35, please use "Tumor stage" instead of "Tumor depth"
11) What do you mean by "The EUS image features of each tumor T stage could
guide judgment for EUS gastroenterologist."?
12) Line 52: what is the "reinforced TNM"? Maybe you mean updated?
13) Please revise English expression throughout the text
References
Please include the following relevant references
- Fusaroli, P., Kypreos, D., Alma Petrini, C.A., Caletti, G. Scientific publications
in endoscopic ultrasonography: Changing trends in the third millennium. Journal
of Clinical Gastroenterology 2011;45: 400-404.
- Catena, F., Di Battista, M., Ansaloni, L., Pantaleo, M., Fusaroli, P., Di Scioscio,
V., Santini, D., Nannini, M., Saponara, M., Ponti, G., Persiani, R., Delrio, P.,
Coccolini, F., Di Saverio, S., Biasco, G., Lazzareschi, D., Pinna, A. Microscopic
margins of resection influence primary gastrointestinal stromal tumor survival.
Onkologie 2012;35:645-648.
- Caletti, G., Fusaroli, P. The rediscovery of endoscopic ultrasound (EUS) in
gastric cancer staging. Endoscopy 2012;44:553-555.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Reviewer’s report
Title: 
The New American Joint Committee on Cancer T Staging System for
Stomach: Increased Complexity without Clear Improvement in Predictive
Accuracy for Endoscopic Ultrasound
Version: 
1 
Date: 
02 Jun 2020
Reviewer's report:
The authors presented a retrospective analysis of clinical and EUS imaging
features of 348 patients with gastric cancer who underwent radical resection
comparing preoperative staging by EUS using either the 6th, 7th or 8th edition of
TNM.
Introduction
1) I do not understand the expression "monotonicity of gradients"
2) Please revise English expression throughout the text
Methods
3) Line 16, please amend as "…they underwent pre-operative staging by EUS"
4) Line 38, maybe you mean that both linear and radial echoendoscopes were
used? Please specify. Amend "heteroscope"
5) Please explain how was the restaging performed. Based on videos? Still
images? Report? Who performed the restaging? How was consensus reached in
case of disagreement? 
Results
6) Please explain which classification was used during the exam, in real time.
6th, 7th or 8th? If different classifications were used according to the different
time periods of enrollment, please specify how many patients were enrolled
according to the classification used in real time.
7) Instead of "EUS type" please use "echoendoscope type"
8) Page 7, line 21, please amend as "…EUS accuracy was not influenced by the
size of the gastric lesion or presence of ascites."
9) Line 29, please use "angulus" instead of "angle"
Discussion
10) Line 35, please use "Tumor stage" instead of "Tumor depth"
11) What do you mean by "The EUS image features of each tumor T stage could
guide judgment for EUS gastroenterologist."?
12) Line 52: what is the "reinforced TNM"? Maybe you mean updated?
13) Please revise English expression throughout the text
References
Please include the following relevant references
- Fusaroli, P., Kypreos, D., Alma Petrini, C.A., Caletti, G. Scientific publications
in endoscopic ultrasonography: Changing trends in the third millennium. Journal
of Clinical Gastroenterology 2011;45: 400-404.
- Catena, F., Di Battista, M., Ansaloni, L., Pantaleo, M., Fusaroli, P., Di Scioscio,
V., Santini, D., Nannini, M., Saponara, M., Ponti, G., Persiani, R., Delrio, P.,
Coccolini, F., Di Saverio, S., Biasco, G., Lazzareschi, D., Pinna, A. Microscopic
margins of resection influence primary gastrointestinal stromal tumor survival.
Onkologie 2012;35:645-648.
- Caletti, G., Fusaroli, P. The rediscovery of endoscopic ultrasound (EUS) in
gastric cancer staging. Endoscopy 2012;44:553-555.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Please review this paper.
user
Reviewer’s report
Title: 
The New American Joint Committee on Cancer T Staging System for
Stomach: Increased Complexity without Clear Improvement in Predictive
Accuracy for Endoscopic Ultrasound
Version: 
1 
Date: 
02 Jun 2020
Reviewer's report:
The authors presented a retrospective analysis of clinical and EUS imaging
features of 348 patients with gastric cancer who underwent radical resection
comparing preoperative staging by EUS using either the 6th, 7th or 8th edition of
TNM.
Introduction
1) I do not understand the expression "monotonicity of gradients"
2) Please revise English expression throughout the text
Methods
3) Line 16, please amend as "…they underwent pre-operative staging by EUS"
4) Line 38, maybe you mean that both linear and radial echoendoscopes were
used? Please specify. Amend "heteroscope"
5) Please explain how was the restaging performed. Based on videos? Still
images? Report? Who performed the restaging? How was consensus reached in
case of disagreement? 
Results
6) Please explain which classification was used during the exam, in real time.
6th, 7th or 8th? If different classifications were used according to the different
time periods of enrollment, please specify how many patients were enrolled
according to the classification used in real time.
7) Instead of "EUS type" please use "echoendoscope type"
8) Page 7, line 21, please amend as "…EUS accuracy was not influenced by the
size of the gastric lesion or presence of ascites."
9) Line 29, please use "angulus" instead of "angle"
Discussion
10) Line 35, please use "Tumor stage" instead of "Tumor depth"
11) What do you mean by "The EUS image features of each tumor T stage could
guide judgment for EUS gastroenterologist."?
12) Line 52: what is the "reinforced TNM"? Maybe you mean updated?
13) Please revise English expression throughout the text
References
Please include the following relevant references
- Fusaroli, P., Kypreos, D., Alma Petrini, C.A., Caletti, G. Scientific publications
in endoscopic ultrasonography: Changing trends in the third millennium. Journal
of Clinical Gastroenterology 2011;45: 400-404.
- Catena, F., Di Battista, M., Ansaloni, L., Pantaleo, M., Fusaroli, P., Di Scioscio,
V., Santini, D., Nannini, M., Saponara, M., Ponti, G., Persiani, R., Delrio, P.,
Coccolini, F., Di Saverio, S., Biasco, G., Lazzareschi, D., Pinna, A. Microscopic
margins of resection influence primary gastrointestinal stromal tumor survival.
Onkologie 2012;35:645-648.
- Caletti, G., Fusaroli, P. The rediscovery of endoscopic ultrasound (EUS) in
gastric cancer staging. Endoscopy 2012;44:553-555.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
assistant