Potential Role of PSMA-Targeted PET in Thyroid Malignant Disease: A Systematic Review
Round 1
Reviewer 1 Report
Dear Authors.
The article is interesting and I enjoyed reading it. Thyroid cancer represents a major topic in endocrinology, nuclear medicine, and endocrine surgery, as well from a public health perspective due to its epidemiological impact. That is why new diagnostic options in severe and challenging cases might bright useful clues in thyroid malignancy – associated overall approach.
Here are my observations which I consider as minor suggestions:
1. Abstract – I suggest a few hard data (number) based on your systemic review should be provided in Abstract in addition to the number of papers and number of patients you identified
2. Introduction – Line 70 – Please cite a reference concerning “RECIST”
3. Results – Did the included patients in those studies have a histological confirmation with regarding to the mentioned imaging scans?
4. Discussion – Since there are only a few studies regarding this particular matter with a small number of patients, do you think that incorporating in the final analyze, for instance, at Discussion the case reports you already identify would bring some value to our current understanding, for instance, the data from Table 2:
Verburg, F.A. 2015
Damle, N.A 2016
Taywade, S.K 2016
Derlin, T 2017
Jena, A.; 2017
Kirchner, J. 2017
Damle, N.A.; 2018
Sasikumar, A. 2018
Singh, D.; 2018
Ciappuccini, R 2019
Gossili, F.; 2020
Santhanam, P 2020
Sood, A.; 2020
Tang, K.; 2020
Tupalli, A 2020
Ciappuccini, R.; 2021
Civan, C 2021
Li, H.; 2021
Sonavane, S.N.; 2021
Usmani, S.; 2021
Verma, P 2021
Freesmeyer, M.; 2022
Hasenauer, N 2022
Lu, Y. 2022
Parghane, R.V.; 2022
Rosar, F.; 2022
Thank you,
Best regards,
Author Response
Thanks to the reviewer for the comment and the suggestions.
- Abstract – I suggest a few hard data (number) based on your systemic review should be provided in Abstract in addition to the number of papers and number of patients you identified
According to reviewer suggestions, more data concerning the reported values of detection rate were provided in the Abstract section.
- Introduction – Line 70 – Please cite a reference concerning “RECIST”
We added the reference concerning RECIST as requested.
- Results – Did the included patients in those studies have a histological confirmation with regarding to the mentioned imaging scans?
Most of the included studies did not histologically confirm the malignant nature of the reported lesions, and 5/6 compared the results of PSMA-targeted PET/CT with [18F]FDG PET/CT imaging or, in case of mismatch in doubtful lesions, with MRI. The only study that compared PSMA-targeted PET data with histology/immunohistochemistry was Wächter et al. and their results are reported both in results and discussion sections.
- Discussion – Since there are only a few studies regarding this particular matter with a small number of patients, do you think that incorporating in the final analyze, for instance, at Discussion the case reports you already identify would bring some value to our current understanding, for instance, the data from Table 2:
As stated by the reviewer, only a few studies explored the potential role of PSMA-targeted PET/CT in managing RI-refractory thyroid cancer. Nevertheless, case reports were excluded from the analysis (as stated in the material and method section) since they are a potential source of publication bias (indeed, even including only original studies, we highlighted a significant patient selection bias in the results section due to the low number of included patients).
Author Response File: Author Response.docx
Reviewer 2 Report
This is a well-executed, well-written comprehensive systematic review on the value of the PSMA ligand in differentiated thyroid cancer. It is an interesting topic although not very original (the authors mention multiple other reviews). It summarises the finding of 6 original papers.
Major:
- if SUVmax’es are mentioned, the authors should state whether this was measured using EARL-compliant protocols.
Minor:
- no white line before paragraph 2.2 and 2.3
- 2 times pararagraph 2.2 and 2 times paragraph 3, check numbering
- no white line between table 2 and “several heterogeneities …”
- typo in table 2: Hurtle >> Hürthle
- comparative imaging >> reference imaging?
- “a slight incidence” >> “a low incidence”?
- discussion: consider discussing the role of TSH stimulation in FDG-PET and mentioning if it was done for reference imaging
Author Response
Thanks to the reviewer for the comment and the suggestions.
- if SUVmax’es are mentioned, the authors should state whether this was measured using EARL-compliant protocols
No data about EARL are reported in the included studies.
- no white line before paragraph 2.2 and 2.3
- 2 times pararagraph 2.2 and 2 times paragraph 3, check numbering
- no white line between table 2 and “several heterogeneities …”
- typo in table 2: Hurtle >> Hürthle
- comparative imaging >> reference imaging?
- “a slight incidence” >> “a low incidence”?
- discussion: consider discussing the role of TSH stimulation in FDG-PET and mentioning if it was done for reference imaging
We rephrased as requested by the reviewer.
Concerning the patients' preparation before the [18F]F-FDG PET/CT scan, none of the included studies reported whether the exam was performed under TSH stimulation. We added this sentence in the results section.
Author Response File: Author Response.docx