Reviewer’s report
Title: 
Distribution of breast lesions diagnosed by cytology examination in
symptomatic patients at Eritrean National Health Laboratory, Asmara, Eritrea: a
retrospective study
Version: 
1 
Date: 
16 Feb 2020
Reviewer's report:
Embaye et al. had enough cases showing the distribution of breast diseases using
FNAC among symptomatic patients at ENHL. However, the results were poorly
presented and lack scientific integrity. The following are the general comments
which should be addressed: a) statistical analyses of the collected data need to be
repeated in a more scientific way. Similarly, data were poorly presented in both
tables and figures. For example, there is no need of the pictorial presentation of
distribution of the breast diseases by gender (Figure 1). b) a well-written,
concrete and supportive discussion should be written.
NB: A research paper by Ameya and Yerakly, 2017 titled "Characteristics of
cervical disease among symptomatic women with histopathological sample at
Hawassa University referral hospital, Southern Ethiopia" can help the authors for
a proper write-up of their manuscript.
The specific comments include:
1. The manuscript has a lot of grammatical errors. For example, line 118 should
read "Clinical presentations of the study participants" instead of "Presenting
symptoms of study population". 
2. Line 68-69 should be explained in the inclusion and exclusion criteria.
3. Authors used the words breast "lesions" and breast "diseases" interchangeable.
They need to be consistent in their write-up.
4. Which staining technique was used to classify evaluated cases? That is to say,
they should state the international criteria used in classifying cases of breast
disease. Specifically, line 93, "The slides were stained by (which technique?)"
Similarly, at what magnification levels did a cytohistopathologist conduct
microscopic evaluations? Furthermore, did you use H&E staining technique or
others?
5. Authors should state the reference number of the ethical clearance provided by
the responsible authority. Furthermore, did your study used a standardized
physician's cytopathology request forms? If not, you're supposed to use
standardized request forms in avoiding study biasness.
6. Frequency and number of cases should altogether be written in all tables and if
possible during results presentation. 
7. No any statistical significance was reported in their work. I would advise the
authors to investigate the association of the distribution of breast diseases against
age categories using Pearson chi-squared test.
8. Authors should report micrographs of the stained cases such as fibroadenoma,
ductal carcinoma of the breast, benign breast lesion, fibrocystic disease etc., at
their respective magnifications.
9. In a more summarized way, table 2 should present the most occurring cases of
the breast diseases. For table 3, age can be categorized into the following
categories: ≤ 20, 21- 30, 31 - 40, 41 -50, 51 - 60, 61 - 70 and >70 in order to
group individual cases appearing from 71 yr. of age. Similarly, authors should
provide a figure showing a 5 years trendline of breast diseases in symptomatic
patients at ENHL.
10. In table 3, cases were classified as most common diagnosis and second most
common diagnosis of the cases. What does it mean and what was the essence for
such double classifications of the cases?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
Declaration of competing interests
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questions:
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