A Retrospective Analysis of Diagnostic Breast Imaging Outcomes in Young Women at a Tertiary Care Center

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript describes a retrospective review of a small cohort of younger women (30-50) presenting for diagnostic workup to ascertain if delayed breast cancer diagnosis was occurring in that group.

The manuscript is well organized, easy to understand and will be of interest to readers.  

I have a few small concerns that should be addressed before the manuscript is ready for publication:

1.  In the results n=400 records were identified, but only 171 were determined to be eligible.  What were the reasons for exclusion and their frequency?  (i.e. of the 229 how many were excluded for reason A, how may for reason B, etc).

2. The cohort was selected from January 2018 and December 2019 .   The end date is reasonably close to the COVID interruption in medical services (Spring 2020).   Was there an impact.  Please add a statement  on whether all patients received diagnosis before the interruption or how many might have been impacted by the delay.  (I think only a few of the outliers -- like the 22wk delay may be).  For BIRADS 3 cases, I think this might put them right in the middle of the COVID interruption.  Was there a delay in their 6-month followup? 

3. L174:  "Most importantly there were no breast cancer diagnoses in patients with normal/benign findings on original diagnostic imaging (BIRADS 1 and 2 category)"

       I think there needs to be some clarity here.  Does this statement mean that of the 90 originally given BIRADS 1 or 2   there were no _subsequent_ presentations of breast cancer (screened or diagnostic)?  If so, how long was the followup period to ascertain this? 

Broadening on that, what was the followup period for all subjects in the study ?   This may have an impact on classifying the [BIRADS 0 then BIRADS 3] and [BIRADS 3 then BIRADS 3] subjects (perhaps they go on to have cancer diag at their next visit)

Also there were a number of BIRADS 1 and 2 after initial diag of BIRADS 0 or 3 -- was there also no evidence of cancer diagnoses in these cases?  or was this outside the followup window?

4. "We excluded all patients undergoing routine screening mammography" L79   --  However there are n=10 BIRADS 0 reviews, a category that is generally associated with screening exams.  Were these diagnostic exams that been deemed incomplete/inconclusive and the subjects had (immediate?) subsequent imaging?

5 There were two BIRADS 4 cases in the BIRADS 0 followup.  These do not appear to be included in the biopsy results (which were only on the n=30 initial diagnoses of 4/5).  Is there a reason for this?  Were they included in the time to biopsy calculation? I would imagine having a second round of imaging before biopsy might lead to a significant delay for these two cases.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

1. Based on the content of your research in breast cancer and medical diagnosis, please consider adding the following articles to the Introduction section: 
        1. “Enhanced Moth-Flame Optimizer with Quasi-Reflection and Refraction Learning with Application to Image Segmentation and  Medical Diagnosis”
        2."Attention guided neural ODE network for breast tumor segmentation in medical images"
        3." MFeature: Towards High Performance Evolutionary Tools for Feature Selection. "

2. Please give the complete research Methods in section 2.2 Materials and Methods

3. Please provide a complete diagnostic flow diagram, or diagnostic model diagram

4. Please increase the comparison experiments with other existing methods?

5. Please give the statistical value p-value in the experimental results

Comments on the Quality of English Language

Need improvement

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Provide a more comprehensive description in "Delayed Breast Cancer Diagnosis"，further modifications to the manuscript's grammar will be made.

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

Please see attached

Author Response File: Author Response.pdf

Round 3

Reviewer 2 Report

Comments and Suggestions for Authors

Make minor changes to English grammar.

Comments on the Quality of English Language

Make minor changes to English grammar.