Diagnostic Performance of Preoperative Imaging in Endometrial Cancer

Round 1

Reviewer 1 Report

I read with great interest the manuscript, which falls within the aim of this Journal and offers a high-quality overview of the topic.

Methodology is accurate and conclusions are supported by the data analysis. 

Although the manuscript can be considered already of high quality, I would suggest to take into account the following minor recommendations:

 

- I suggest another round of language revision, in order to correct a few typos and improve readability.

- I find it interesting to include a reference to radiomics analyses in endometrial carcinoma .

- Inclusion/exclusion criteria should be better clarified by extending their description.

- The authors have not adequately highlighted the strengths of their study. I suggest better specifying these points.

I recommend the publication of the article, pending few minor revisions.

 

 

The whole text should be corrected by a native English speaker in order to make the work clearer and more readable.

Author Response

We sincerely appreciate the reviewer’s constructive comments.

Below are point-by-point responses to the comments. Should there be any further concerns regarding our manuscript, we will gladly clarify.

- I suggest another round of language revision, in order to correct a few typos and improve readability.

The language editing has been performed by a professional language editing service.  

- I find it interesting to include a reference to radiomics analyses in endometrial carcinoma .

We appreciate the valuable recommendation from the reviewers. We added discussion about the possibility of integrating radiomics into preoperative assessment in page 11, line 376-387.  

- Inclusion/exclusion criteria should be better clarified by extending their description.

The description for inclusion and exclusion criteria was revised according to the recommendation in page 2, line 82-95.

- The authors have not adequately highlighted the strengths of their study. I suggest better specifying these points.

We added several sentences to highlight the strengths of this study in page 12, line 395-398.

I recommend the publication of the article, pending few minor revisions.

We appreciate your generous consideration for our manuscript.

Reviewer 2 Report

The aim of this study was to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) interpretation results in endometrial carcinoma (EC).

I have the following comments to the Authors:

 

·      Methods: In order to make the study reproducible, Authors should describe material and methods more in details. For example, Authors should describe how were selected the patients included in the study and how was selection bias excluded during this phase.

·      In order to make the article more praiseworthy and stimulate further research about this topic, Authors should include a section describing strengths and limitations of this study.

. Authors should describe also the role of ultrasound in the preoperative diagnosis and staging of EC, which represents a valuable, cheaper and less invasive item and should be mentioned in the discussion section, although not evaluated in this study.

·      Tumor size, which can be evaluated with either CT or ultrasound, has been described as a preoperative prognostic factor for EC. In order to add an interesting and favorable point in the discussion section, Authors may discuss about this prognostic factor  and how could it be integrated in the actual clinical workup of EC (e.g. PMID: 36212493).

Please check for typos and tense mistakes

Author Response

We sincerely appreciate the reviewer’s constructive comments.

Below are point-by-point responses to the comments.

We would like to inform the reviewer that Table S6 in supplementary information was wrongly uploaded in the primary submission, which was replaced with the appropriate one. It would be appreciated if the reviewer and editor accept this revision. We also would like to inform that there are minor grammatical changes as a result of second round of English proofread.

Should there be any further concerns regarding our manuscript, we will gladly clarify.

 

 

The aim of this study was to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) interpretation results in endometrial carcinoma (EC).

I have the following comments to the Authors:

 

 Methods: In order to make the study reproducible, Authors should describe material and methods more in details. For example, Authors should describe how were selected the patients included in the study and how was selection bias excluded during this phase.

We appreciate your suggestion. According to the recommendation, the description in materials and methods was revised (page 2, line 80-95).

 In order to make the article more praiseworthy and stimulate further research about this topic, Authors should include a section describing strengths and limitations of this study.

We revised the discussion to highlight the strengths and limitations of the current study in page 12, line 388-398. Thank you for your suggestion.

 Authors should describe also the role of ultrasound in the preoperative diagnosis and staging of EC, which represents a valuable, cheaper and less invasive item and should be mentioned in the discussion section, although not evaluated in this study.

We absolutely agree with the reviewer’s suggestion. We added discussion about the value of transvaginal ultrasound focusing on evaluating myometrial invasion and cervical stromal invasion in page 10, line 317-323.

Tumor size, which can be evaluated with either CT or ultrasound, has been described as a preoperative prognostic factor for EC. In order to add an interesting and favorable point in the discussion section, Authors may discuss about this prognostic factor  and how could it be integrated in the actual clinical workup of EC (e.g. PMID: 36212493).

We appreciate your valuable comment regarding preoperative tumor size, which was additionally discussed with the suggested references in page 11, line 345-350.

 

Reviewer 3 Report

1. Probably, with what risk factors⁷, the pre-OP image may consider MRI or CT should be listed up inside the discussion.

2. The cost effect and waiting time to CT and MRI may also need to be mentioned inside the discussion.

3.How did you decide the choice of the pelvic lymphadenectomy "with" or "without" the para-aortic lymphadenectomy?

4.Would you suggest use the negative finding of CT/MRI about the lymph node metastasis to decide the avoidance of pelvic/para-aortic lymphadenectomy?

 

Author Response

We sincerely appreciate the reviewer’s constructive comments.

Below are point-by-point responses to the comments.

We would like to inform the reviewer that Table S6 in supplementary information was wrongly uploaded in the primary submission, which was replaced with the appropriate one. It would be appreciated if the reviewer and editor accept this revision. We also would like to inform that there are minor grammatical changes as a result of second round of English proofread.

Should there be any further concerns regarding our manuscript, we will gladly clarify.

 

1. Probably, with what risk factors⁷, the pre-OP image may consider MRI or CT should be listed up inside the discussion.

At our institution, we routinely perform both systemic CT and MRI for every patient regardless of the types of risk factor if a patient does not have contraindications. Thus, we do not have enough data or background to discuss the stratification of the indication for CT or MRI according to risk factors in this study. Instead, we clarified the basic policy for preoperative clinical imaging at our institution in page 2, line 80-81. It would be grateful if you agree with our revision about this issue.

2. The cost effect and waiting time to CT and MRI may also need to be mentioned inside the discussion.

Thank you for pointing out the important concern. We added the data about the time interval between the acquisition of clinical image and surgery in page 5, line 145-146. Also, cost-effectiveness and time interval were additionally discussed in page 351-375.  

3. How did you decide the choice of the pelvic lymphadenectomy "with" or "without" the para-aortic lymphadenectomy?

The basic indication for para-aortic lymphadenectomy at our institution was added in page 5, line 151-153.

4. Would you suggest use the negative finding of CT/MRI about the lymph node metastasis to decide the avoidance of pelvic/para-aortic lymphadenectomy

We appreciate your comment. Regarding this point, we added discussion in page 11, line 342-344.

 

Reviewer 4 Report

Dear Authors, 

I have read your manuscript with real interest because of the importance of the topic and the resonance of it. I think it should be published to supply a more recent point of view on preoperative workup of endometrial cancer patiens.

The main questions addressed by the study are the role of diagnostic tools like CT, PET/CT, and MRI for preoperative workup of Endometrial Cancer patients. The topic is relevant in the field because it is a relevant and still actual topic. It adds to the subject area compared with other published material more details about the sensitivity and specificity of instrumental diagnostic tools and comparison between them. Tailoring of the preoperative diagnostic workup in Endometrial Cancer patients can be improved. The conclusions are consistent with the evidence and arguments presented and they address the main question posed. The references are appropriate. The tables are good styled.

Author Response

We sincerely appreciate your constructive comments.

We have revised our manuscript according to all reviewers' comments.

We would like to inform the reviewer that Table S6 in supplementary information was wrongly uploaded in the primary submission, which was replaced with the appropriate one. It would be appreciated if the reviewer and editor accept this revision. We also would like to inform that there are minor grammatical changes as a result of second round of English proofread.

Should there be any further concerns regarding our manuscript, we will gladly clarify.

Again, thank you for sparing your time for reviewing our manuscript.

Reviewer 5 Report

Dear Authors,

I read your work and I found it very interesting, but I have some recommendations that may improve your manuscript.

The abstract in relevant, although I recommend to use the structure of introduction, material and methods, results and conclusions.

The introduction is well written and adequate to the text.

The methodology is clearly described.

The results are sustained by relevant tables and graphics.

The discussion section is detailed but I do not understand why is a red marked paragraph.

I recommend a more clear conclusion section.

 

Author Response

We sincerely appreciate the reviewer’s constructive comments.

Below are point-by-point responses to the comments.

We would like to inform the reviewer that Table S6 in supplementary information was wrongly uploaded in the primary submission, which was replaced with the appropriate one. It would be appreciated if the reviewer and editor accept this revision. We also would like to inform that there are minor grammatical changes as a result of second round of English proofread.

Should there be any further concerns regarding our manuscript, we will gladly clarify.

 

I read your work and I found it very interesting, but I have some recommendations that may improve your manuscript.

 

The abstract in relevant, although I recommend to use the structure of introduction, material and methods, results and conclusions.

Thank you for your suggestion. We have revised the style of our abstract accordingly.

The introduction is well written and adequate to the text.

The methodology is clearly described.

The results are sustained by relevant tables and graphics

Again, we appreciate your generous comments and consideration.

The discussion section is detailed but I do not understand why is a red marked paragraph.

Our apologies for unnecessary highlight in the initial submission. In the revised manuscript, revised sentences were highlighted.

I recommend a more clear conclusion section.

We revised our conclusion according to your comment and the comments from the other reviewers. (page 12, line 399-406) Thank you for pointing this out.

Round 2

Reviewer 1 Report

Thank you for going through the manuscript and the reviewers' points
In my honest opinion, the authors have responded satisfactorily to the reviewers’ criticisms.
The manuscript is well written and falls within the aim of this Journal.

Reviewer 3 Report

Accept for publication.