Review for 10.1186/s12876-020-01582-8 (2021)

Reviewer’s report
Title: 
Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower
gastrointestinal tract approaches
Version: 
0 
Date: 
14 Aug 2020
Reviewer's report:
Mita et al performed a single-center retrospective study on the technical and diagnostic success of upper
and lower GI EUS-FNA on pelvic lesions. In my opinion in this article, some issues should be further
addressed.
1) In this paper, in the majority of cases, the pelvic lesions taken into account were lymph nodes diseases
(lymphomas, metastatic lymph nodes, benign lymphadenopathies…).
- The median diameter of the lesions was quietly large (about 40 mm). Why it was decided to perform as
first approach the EUS-FNA and not other techniques such as a percutaneous/transvaginal one or the
excision of a superficial lymph node?
- It should be interesting if you report in the discussion section a comparison with the results obtained
with the transvaginal approach.
- Considering that most of your cases were lymphadenopathies, comment in Discussion which are the
peculiarities of your article respect to others in the literature.
2) In my opinion, GI submucosal lesions should be excluded from the analysis because they cannot really
be considered pelvic lesions.
3) In the methods section, you said that a smear was prepared with the remaining specimens. Did you find
differences in terms of diagnostic accuracy between smears and histological specimens?
4) Specify how many passes (median and IQR) did you perform to obtain a macroscopically valid
histological specimen
5) Did you find differences in terms of feasibility and diagnostic accuracy among different needle sizes? 
6) Please, specify the definition of adverse events. Did you consider also minor AEs, such as self-limiting
bleedings, abdominal pain, fever,…?
7) Was the colonoscopy for the lower EUS-FNA really necessary?
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
Yes
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Yes
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Yes
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No
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manipulation?
Yes