Apparent Diffusion Coefficient Value as a Biomarker for Detecting Muscle-Invasive and High-Grade Bladder Cancer: A Systematic Review

Round 1

Reviewer 1 Report

The authors reviewed the role of the apparent diffusion coefficient (ADC) value of diffusion-weighted magnetic resonance imaging as a biomarker of high-grade and invasive bladder cancer. The authors have concluded that the ADC value could be a non-invasive diagnostic biomarker for discriminating muscle-invasive and high-grade bladder cancer. It is a well-organized paper and well-written paper. However, there are some concerns about this article. 1. This type of review article has already been published previously. The authors should clearly state what new evidence is in the paper compared to other review articles.2. The literature search method is inefficient (e.g., The authors only search PubMed and Coherence Library). 3. What are primary and secondary outcomes? There seem no comparisons in the article.4. There are no original MRI images. The authors should present their authentic experiences. 5. Is there any perspective on the yield of this study?

Author Response

Please see the attachment.

Author Response File: Author Response.doc

Reviewer 2 Report

In recent years, non-invasive diagnostic techniques are becoming more and more important in neoplasm grading and neoplasm staging. This paper assessed the role of ADC values in differentiating MIBC and high-grade bladder cancer from NMIBC and low-grade bladder cancer, respectively.

But some content need to be improved. Here are some suggestions :

 

1. The basic information of patients in each group werenot described, and whether the groups were consistent.  
2. Give a detailed description of how to calculate median (range) sensitivity, specificity, and AUCvalues, and whether to consider the different number of patients in each study.
3. Rosenkrantz [16] in Table 3 has no statistical significance, and the possible causes are not analyzed in this paper.  
4. In the discussion part, the advantages of ADC values compared with other quantitative parameters in evaluating the clinical aggressiveness of bladder cancer should be added.  

Author Response

Please see the attachment.

Author Response File: Author Response.doc

Round 2

Reviewer 1 Report

It is well revised. There are no further comments.