Title: Serrated Polyps in Colorectal Cancer Prevention: Prevalence, Characteristics, and Clinical
Insights from a Large Retrospective Cohort Study
Version: 1 Date: 09 Jun 2025
Reviewer's report:
Firstly, the WHO definition of SSP changed during study period in this article. Please specify
what definition was used in your study and what was done to address this issue. Pathologic
diagnosis was also not mentioned whether central review was used, which may have a
misclassification SSP as HP. For serrated polyps and hyperplastic polyps (no-serrated) in the
draft, a definition section suggested to be added to clarify the terminology in detail and most
of SPs described in the manuscript are more likely to be SSL specified by WHO according the
results.
Secondly, the manuscript did not describe withdrawal time as a key quality indicator, which has
an impact on SPPs detection rate. When following the guideline, a withdrawal time > 6 min is a
basic requirement for standard colonoscopy and restrictions for this in the study are not yet clear.
These deficiencies in method section need to be further refined and described in the manuscript.
Thirdly, we recommend the authors carefully interpret critical results. According to the
description in context, the SPs mentioned refers to SSPs. The results showed a lower SP
detection rate (2.98%) and a higher HGD rate in SPs (21.3%) compared with previous studies.
ACG/ASGE Quality Task Force’ recommended minimum threshold of 6% about SSLDR and
this result is also notably lower than the prevalence of 4.6% reported in a systematic review of
global studies. Meanwhile, SSLDs are not frequently found, occurring in approximately 0.5%
of average-risk patients (approximately 4-8% of all SSLs) according to other studies. Failure
to perform uniform pathology center reading may be one of the causes. The manuscript should
more critically in explaining the limitations of the results and data.
Fourthly, references require consolidation and to add key citations. The reference list contains
duplicate citations as ref 8 and 13, and the authors should to recheck it. Meanwhile the
manuscript lacks foundational supporting references. For instance, IJspeert et al. (2017) should
be cited for defining endoscopic features for SSLs (e.g., cloud-like surface, mucus cap) and the
2019 WHO classification of tumors of the digestive system should also be cited.
Finally, the language of manuscript is slightly imprecise and graphical presentation need to be
optimized. Additional information be included in the manuscript for the undefined size and shape
of the polyps in Table 1. Similarly, description of polyp size has some errors in Fig. 2.
Title: Serrated Polyps in Colorectal Cancer Prevention: Prevalence, Characteristics, and Clinical
Insights from a Large Retrospective Cohort Study
Version: 1 Date: 09 Jun 2025
Reviewer's report:
Firstly, the WHO definition of SSP changed during study period in this article. Please specify
what definition was used in your study and what was done to address this issue. Pathologic
diagnosis was also not mentioned whether central review was used, which may have a
misclassification SSP as HP. For serrated polyps and hyperplastic polyps (no-serrated) in the
draft, a definition section suggested to be added to clarify the terminology in detail and most
of SPs described in the manuscript are more likely to be SSL specified by WHO according the
results.
Secondly, the manuscript did not describe withdrawal time as a key quality indicator, which has
an impact on SPPs detection rate. When following the guideline, a withdrawal time > 6 min is a
basic requirement for standard colonoscopy and restrictions for this in the study are not yet clear.
These deficiencies in method section need to be further refined and described in the manuscript.
Thirdly, we recommend the authors carefully interpret critical results. According to the
description in context, the SPs mentioned refers to SSPs. The results showed a lower SP
detection rate (2.98%) and a higher HGD rate in SPs (21.3%) compared with previous studies.
ACG/ASGE Quality Task Force’ recommended minimum threshold of 6% about SSLDR and
this result is also notably lower than the prevalence of 4.6% reported in a systematic review of
global studies. Meanwhile, SSLDs are not frequently found, occurring in approximately 0.5%
of average-risk patients (approximately 4-8% of all SSLs) according to other studies. Failure
to perform uniform pathology center reading may be one of the causes. The manuscript should
more critically in explaining the limitations of the results and data.
Fourthly, references require consolidation and to add key citations. The reference list contains
duplicate citations as ref 8 and 13, and the authors should to recheck it. Meanwhile the
manuscript lacks foundational supporting references. For instance, IJspeert et al. (2017) should
be cited for defining endoscopic features for SSLs (e.g., cloud-like surface, mucus cap) and the
2019 WHO classification of tumors of the digestive system should also be cited.
Finally, the language of manuscript is slightly imprecise and graphical presentation need to be
optimized. Additional information be included in the manuscript for the undefined size and shape
of the polyps in Table 1. Similarly, description of polyp size has some errors in Fig. 2.
Please review this paper.
user
Title: Serrated Polyps in Colorectal Cancer Prevention: Prevalence, Characteristics, and Clinical
Insights from a Large Retrospective Cohort Study
Version: 1 Date: 09 Jun 2025
Reviewer's report:
Firstly, the WHO definition of SSP changed during study period in this article. Please specify
what definition was used in your study and what was done to address this issue. Pathologic
diagnosis was also not mentioned whether central review was used, which may have a
misclassification SSP as HP. For serrated polyps and hyperplastic polyps (no-serrated) in the
draft, a definition section suggested to be added to clarify the terminology in detail and most
of SPs described in the manuscript are more likely to be SSL specified by WHO according the
results.
Secondly, the manuscript did not describe withdrawal time as a key quality indicator, which has
an impact on SPPs detection rate. When following the guideline, a withdrawal time > 6 min is a
basic requirement for standard colonoscopy and restrictions for this in the study are not yet clear.
These deficiencies in method section need to be further refined and described in the manuscript.
Thirdly, we recommend the authors carefully interpret critical results. According to the
description in context, the SPs mentioned refers to SSPs. The results showed a lower SP
detection rate (2.98%) and a higher HGD rate in SPs (21.3%) compared with previous studies.
ACG/ASGE Quality Task Force’ recommended minimum threshold of 6% about SSLDR and
this result is also notably lower than the prevalence of 4.6% reported in a systematic review of
global studies. Meanwhile, SSLDs are not frequently found, occurring in approximately 0.5%
of average-risk patients (approximately 4-8% of all SSLs) according to other studies. Failure
to perform uniform pathology center reading may be one of the causes. The manuscript should
more critically in explaining the limitations of the results and data.
Fourthly, references require consolidation and to add key citations. The reference list contains
duplicate citations as ref 8 and 13, and the authors should to recheck it. Meanwhile the
manuscript lacks foundational supporting references. For instance, IJspeert et al. (2017) should
be cited for defining endoscopic features for SSLs (e.g., cloud-like surface, mucus cap) and the
2019 WHO classification of tumors of the digestive system should also be cited.
Finally, the language of manuscript is slightly imprecise and graphical presentation need to be
optimized. Additional information be included in the manuscript for the undefined size and shape
of the polyps in Table 1. Similarly, description of polyp size has some errors in Fig. 2.
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