Reviewer ’s report  
 
Title: Defining the short -term disease recurrence after Loop Electrosurgical Excision Proce dure 
(LEEP)  
 
Version: 0 Date: 20 Oct 2019  
 
Reviewer: Caio Hartman  
  
Reviewer's report:  
Abstract and Key W ords 
Page 3 - Lines - Suggestion to rephrase: ......31 (14%) women had "major" or "abnormal" 
findings in colposcopy. Of these, 7(32%), underwent further treatment....  
 
Page 3 - Lines 7 -12 - It's not clear to me. If 31 patients had a subsequent visit and 7  underwent 
further treatment, 24 patients are missing. You wrote 23 had a third negative visit. In the results 
section, you explain the 1 more patient as a persistent LSIL, but it must be clear since the 
beginning.  
 
Introduction  
Page 4 - Lines 21 -22 - Suggestion: suppress "high -grade -dysplasia". Keep only "High Grade 
Squamous Intraepithelial Lesion / Cervical Intraepithelial Neoplasia" (HSIL/CIN2 -3). 
 
Page 4 - Lines 38 -43 - Suggestion to rephrase: The current practice and recommen dation in 
Canada is two visits, including cytology, endocervical curettage and colposcopy with biopsy, if 
necessary, at 6 -month intervals.......  
 
Page 4 - Line 46: Suggestion: suppress the word "colposcopic" before follow up. I understood 
you meant follow up with: HPV test plus cytology at 6 -months.  
 
Page 5 - Line 7 -8: Suggestion: This study aims to quantify the prevalence of disease recurrence 
(HSIL/CIN 2 -3) in the second visit at 12 months,  after one negative colposcopic follow -up visit 
in this unique de mographic and treatment modality.  
 
Methods  
As the combined technique (LEEP plus Laser) is uncommon, I suggest you to explain in details 
in which situations this combined technique is used, the main reason to use, and in which 
situations it is not used, in  your service. This is important because you're evaluating recurrence 
of CIN after this combined technique.  
 
Page 5 - Line 58 - It's not clear to me "LEEPs which were positive for CIN2/3" were excluded..... 
Diagnostic LEEPs, with positive surgical resecti on margins for CIN2/3 were excluded........ - Is 
this what you meant?  
 
Results  
Page 7 - Line 14 - I suggest you to describe why 19 biopsies were performed, and which was the 
criteria to perform or not the ECC in these women because 181 women underwent and  ECC at 6 
months and 40 didn't (colposcopic findings?)  
 
Page 7 - Line 19 - Add the number 178 before the percentage, and correct the percentage to 
80.5% as showed in Table 3. Which was the criteria to perform or not the ECC (19.4% not done) 
(colposcopic fi ndings?)  
 
Discussion  
Page 8 - Line 38 -39 - Suggestion: .....having two 'negative' post -LEEP colposcopic 
assessments.....    Add 'and cytologic' after colposcopic.  
 
Page 8 -  Line 53 - I suggest you to explain in details the routine of your service. When L ASER 
is indicated? Dou you perform a LEEP with a smaller depth and add LASER technique? You 
described that (145) 65.6% of your patients did not use LASER.   
 
Page 9 - 3rd Paragraph - Regarding conization depth and obstetrical adverse outcomes, previous 
studies, show that for HSIL treatment, a conization height up to 10 mm is safe.  
 
Suggestions  
Kyrgiou M et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and 
early invasive disease according to cone depth: systematic review and meta -analysis. BMJ. 
2016;354:i3633.  
 
Ang C et al. Histological recurrence and depth of loop  treatment of the cervix in women of 
reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG. 2011;118:685 -
692.  
 
Weinmann S et al. Pregnancy outcomes after treatment for cervical cancer precursor lesions: an 
observational study. PLoS ONE. 2017;12(1):e0165276. doi:10.1371/journal.pone.0165276.  
 
I have read and reviewed your article very carefully.  
I made some suggestions, as they were my doubts during the reading and probably will be the 
same questions of the readers.  
Main issue to be solved: explain in details the use of LASER in your service. When to use, when 
no to use and how to use this technique.  
Maybe you should compare groups (LEEP x LEEP+LASER) in terms of recurrence.  
 
It's a interesting research.  
 
 
Best Regards.  
 
 
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.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is y es to any, please give details below.  
 
I declare that I have no competing interest  
 
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