Title: Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for
gastrointestinal subepithelial lesions: a multicenter retrospective study
Version: 0 Date: 30 Mar 2025
Reviewer's report:
The study addresses an important clinical issue—improving diagnostic accuracy of MEUS for
gastrointestinal SELs and the study design is robust, with clear inclusion/exclusion criteria and
a multi-center dataset.
However, some areas of potential improvement could be:
1. There are some awkward phrasings and minor grammatical errors. For example:
a) "Microprobe endoscopic ultrasonography (MEUS) has gained widespread adoption in
primary hospitals due to its affordability and easy of user." Consider rephrasing it.
b) "The study aims to evaluate the diagnostic accuracy of MEUS for classifying SELs, identifies
key influencing factors, and explores strategies to enhance diagnostic accuracy." Consider
rephrasing it.
2. Sometimes "diagnostic accuracy" is used inconsistently—ensure it is used in a uniform way.
3. Instead of “misdiagnosed as,” consider using “incorrectly classified as” for a more precise
clinical tone.
4. It is mentioned that forward-viewing or standard oblique-viewing linear echoendoscopes were
excluded. Could you clarify why? Was this to maintain uniformity across MEUS examinations?
5. Consider specifying how "unclear pathological diagnoses" were defined—were these cases
with ambiguous histology, inadequate biopsy samples, or conflicting pathology reports?
6. With respect to different ultrasound probes (Olympus, INNERMED), were there any
differences in image quality or resolution between them? If so, could this have influenced
diagnostic accuracy?
7. The study states: "Among 896 lesions across 31 SEL types, the overall DA was 70.31%."
Please include a brief summary of how this compares to prior EUS studies.
8. The subgroup analysis on gastric leiomyomas (DA 9.85%, misdiagnosed as GIST 99.17%) is
striking. It would be useful to discuss why this happens—does MEUS have limited resolution
in differentiating their structural differences? Are there echotextural overlaps?
9. The description of in-homogeneous echoes in gastric GISTs is excellent. However, a figure
or table summarising these key features visually would improve clarity.
10. The conclusion states: "Improving the analysis of echo heterogeneity and expanding
knowledge of atypical and rare cases could enhance diagnostic accuracy."
a) Consider adding specific recommendations for clinical practice. Should training programs
emphasise recognising in-homogeneous patterns? Should AI-assisted analysis be explored?
b) Could further prospective studies using AI-based image analysis or advanced imaging
techniques refine MEUS accuracy?
Title: Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for
gastrointestinal subepithelial lesions: a multicenter retrospective study
Version: 0 Date: 30 Mar 2025
Reviewer's report:
The study addresses an important clinical issue—improving diagnostic accuracy of MEUS for
gastrointestinal SELs and the study design is robust, with clear inclusion/exclusion criteria and
a multi-center dataset.
However, some areas of potential improvement could be:
1. There are some awkward phrasings and minor grammatical errors. For example:
a) "Microprobe endoscopic ultrasonography (MEUS) has gained widespread adoption in
primary hospitals due to its affordability and easy of user." Consider rephrasing it.
b) "The study aims to evaluate the diagnostic accuracy of MEUS for classifying SELs, identifies
key influencing factors, and explores strategies to enhance diagnostic accuracy." Consider
rephrasing it.
2. Sometimes "diagnostic accuracy" is used inconsistently—ensure it is used in a uniform way.
3. Instead of “misdiagnosed as,” consider using “incorrectly classified as” for a more precise
clinical tone.
4. It is mentioned that forward-viewing or standard oblique-viewing linear echoendoscopes were
excluded. Could you clarify why? Was this to maintain uniformity across MEUS examinations?
5. Consider specifying how "unclear pathological diagnoses" were defined—were these cases
with ambiguous histology, inadequate biopsy samples, or conflicting pathology reports?
6. With respect to different ultrasound probes (Olympus, INNERMED), were there any
differences in image quality or resolution between them? If so, could this have influenced
diagnostic accuracy?
7. The study states: "Among 896 lesions across 31 SEL types, the overall DA was 70.31%."
Please include a brief summary of how this compares to prior EUS studies.
8. The subgroup analysis on gastric leiomyomas (DA 9.85%, misdiagnosed as GIST 99.17%) is
striking. It would be useful to discuss why this happens—does MEUS have limited resolution
in differentiating their structural differences? Are there echotextural overlaps?
9. The description of in-homogeneous echoes in gastric GISTs is excellent. However, a figure
or table summarising these key features visually would improve clarity.
10. The conclusion states: "Improving the analysis of echo heterogeneity and expanding
knowledge of atypical and rare cases could enhance diagnostic accuracy."
a) Consider adding specific recommendations for clinical practice. Should training programs
emphasise recognising in-homogeneous patterns? Should AI-assisted analysis be explored?
b) Could further prospective studies using AI-based image analysis or advanced imaging
techniques refine MEUS accuracy?
Please review this paper.
user
Title: Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for
gastrointestinal subepithelial lesions: a multicenter retrospective study
Version: 0 Date: 30 Mar 2025
Reviewer's report:
The study addresses an important clinical issue—improving diagnostic accuracy of MEUS for
gastrointestinal SELs and the study design is robust, with clear inclusion/exclusion criteria and
a multi-center dataset.
However, some areas of potential improvement could be:
1. There are some awkward phrasings and minor grammatical errors. For example:
a) "Microprobe endoscopic ultrasonography (MEUS) has gained widespread adoption in
primary hospitals due to its affordability and easy of user." Consider rephrasing it.
b) "The study aims to evaluate the diagnostic accuracy of MEUS for classifying SELs, identifies
key influencing factors, and explores strategies to enhance diagnostic accuracy." Consider
rephrasing it.
2. Sometimes "diagnostic accuracy" is used inconsistently—ensure it is used in a uniform way.
3. Instead of “misdiagnosed as,” consider using “incorrectly classified as” for a more precise
clinical tone.
4. It is mentioned that forward-viewing or standard oblique-viewing linear echoendoscopes were
excluded. Could you clarify why? Was this to maintain uniformity across MEUS examinations?
5. Consider specifying how "unclear pathological diagnoses" were defined—were these cases
with ambiguous histology, inadequate biopsy samples, or conflicting pathology reports?
6. With respect to different ultrasound probes (Olympus, INNERMED), were there any
differences in image quality or resolution between them? If so, could this have influenced
diagnostic accuracy?
7. The study states: "Among 896 lesions across 31 SEL types, the overall DA was 70.31%."
Please include a brief summary of how this compares to prior EUS studies.
8. The subgroup analysis on gastric leiomyomas (DA 9.85%, misdiagnosed as GIST 99.17%) is
striking. It would be useful to discuss why this happens—does MEUS have limited resolution
in differentiating their structural differences? Are there echotextural overlaps?
9. The description of in-homogeneous echoes in gastric GISTs is excellent. However, a figure
or table summarising these key features visually would improve clarity.
10. The conclusion states: "Improving the analysis of echo heterogeneity and expanding
knowledge of atypical and rare cases could enhance diagnostic accuracy."
a) Consider adding specific recommendations for clinical practice. Should training programs
emphasise recognising in-homogeneous patterns? Should AI-assisted analysis be explored?
b) Could further prospective studies using AI-based image analysis or advanced imaging
techniques refine MEUS accuracy?
assistant