Reviewer's report
Title:The biology of malignant breast tumors has an impact on the presentation
in ultrasound: An analysis of 315 cases
Version: 1Date:29 April 2013
Reviewer: Tibor Tot
Reviewer's report:
Studying the relation of the gross/subgross morphology and the biological
parameters of breast lesions is an important and relevant issue. Regarding US,
the number of such publications are relatively limited, thus the present study, with
its detailed and systematic approach, is worth publishing. However, I suggest
modifications of the manuscript.
Major Compulsory Revisions:
1. There are books, book chapters and articles published on the subject of the
relation of subgross morphology and tumor type, grade, ER status, HER2 status
and molecular phenotypes. Some of them are basic teaching material and cannot
be just disregarded.
2. It is insufficient to type breast carcinomas into ductal and lobular categories.
Where are the mucinous with their round shape, the medullary often immitating a
fibroadenoma ? On the other hand, there are subtypes of invasive lobular
carcinoma clearly deviating from each other in their subgross (the solid subtype
being often circumscribed round/oval mass, the tubulo-lobular a spiculated mass,
the classic "spider's weblike an architectural distortion). I understand that it is
almost impossible to correct this in the study design now, but this should be at
least discussed in the paper.
3. The language of the manuscript is a seemingly correct English. The sentences
do not always cover the intended meaning. Just few examples: Abstract
Background: what does this sentence mean? Breast or other organ ? only tumor
types or also other characteristics. Various subgroups of patients ? suggestion:
The aim of this study was to evaluate the relation of some ultrasound
morphological parameters to biological characteristics in breast carcinoma.
"False negative classification", "advanced sonographer" etc... Strange
terminology. The paper should undergo thorough language editing.
3. The text is too long and contain unnecessary elements. e,g, the part about
Trastuzumab and blood-brain barrier.
4. Do not use "we" in sentences on page 4, reformulate.
5. This reviewer strongly disagrees with the statement on page 4 last sentence.
The clinical characteristics are not dictated by the biological characteristics of the
tumor. The time of detection is more important. The time of the treatment is more
important. The characteristics of the host are important (differences in early vs
advanced BC, treated versus not treated BC etc.).
6. This reviewer also disagrees with the statement that the success of breast
ultrasound can essentially be explained by introduction of BIRADS. There are
countries not using the BIRADS but having excellent sonographers.
7. All the patients have a history of BC in a retrospective study, so the statement
that they were excluded from the study cannot be valid. (page 6 paragraph 1).
Discretionary Revisions
I suggest using the term "histology grade" instead of "grading" and Nottingham
Histology Grade (NHG) instead of Nottingham Grading System.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests