Reviewer’s report
Title: 
Clinical application of the 2011 IFCPC colposcope terminology
Version: 
2 
Date: 
27 Jan 2021
Reviewer's report:
The study by Zhang et al is a retrospective study investigating the association
between the colposcopic findings according to the IFCPC terminology and
histopathologic findings. The study is comprehensive, however, the subject is
heavily covered in the literature. Furthermore, the title is misleading, since the
study does not specifically investigate the role of HPC vaccination. Below are
my specific comments.
Methods:
* The title should be changed. It is misleading, because the presented study does
not consider HPV vaccination, but analyses the diagnostic accuracy of
colposcopy to predict cervical lesions in the general population.
* Why is the study relevant to HPV vaccination? The authors included women
that tested positive for high-risk HPV amongst other indications.
* What were the exclusion criteria for the study? Were all consecutive women
scheduled for colposcopy included or were some women excluded? 
* What was the criteria for "abnormal cervical cytology" as the inclusion to the
study? Did all women have cervical biopsy or conization, even if colposcopy
was normal? In this case, how were the biopsies performed - how many, at
random places, systematically, etc.? 
Please provide additional information about
the selection criteria for the study.
* Please provide more specific definitions on how LSIL and HSIL were defined
histopathologically.
* The results of the ROC curve analyses are not presented, why were ROC
curves used?
Results:
* Table2: The results should show the diagnostic accuracy of the test to detect
the disease and not the diagnostic accuracy to rule out the disease. This would
enhance the interpretability of the results.
* Table 3: In the current version, the percentages in brackets have no clinical
relevance. They should represent the percentage in relation to each
histopathological category. The presentation of the table should also be
improved.
* What was the criterion for abnormal colposcopic finding? It seems that all
women, even those that were categorised as "normal colposcopy" had abnormal
lesions?
Discussion: 
* The first paragraph of the Discussion is too general, redundant, and could be
removed. In general, the discussion could be condensed.
Conclusion:
* Again, although implementation of HPV vaccination will likely change
colposcopy practice in the future, the authors go beyond the findings of the study
by making the first statement. The presented study is not relevant to the
population of HPV vaccinated women. In conclusion, the atuhors should stick to
the findings of the study and refrain from making general assumptions.
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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?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes