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: 
0 
Date: 
17 Aug 2019
Reviewer: 
Ibrahim A.
Reviewer's report:
Dear Respectable Editor 
Thank you very much to give me the opportunity to review the article entitled
(General Trends of Breast Diseases Diagnosed by Cytological Examination in
Symptomatic Patients at Eritrean National Health Laboratory, Asmara, Eritrea; A
Retrospective Study)
The study is a retrospective, descriptive study was carried out on 905
symptomatic patients between the years 2013 and 2017 at Eritrean National
Health Laboratory. Cytological diagnosis was made by FNAC in patients with
palpable breast lump and in some cases direct smear from a nipple discharge was
processed. A total number of 905 cases were included in the study (majority of
subjects, 871 (96%) were females). The age range among study subjects was 13-
93 years. Breast lump, 892 (98.56%) was the most frequent presenting symptom.
Fibroadenoma followed by fibrocystic breast lesion were the most prevalent
disorders in female patients aged 40 years and below. Most malignant breast
lesions, however, were seen in female patients above the age of 40 and in those
age categories between 50-60 years. Gynecomastia 19 (57.58%) was the most
common breast lesion identified in male subjects. In their study, the most
important associations with malignant breast diseases were female sex and age
above 40 years.
The authors concluded that FNAC is a procedure of choice for preoperative
diagnosis of breast pathologies mainly in a resource limited setting. The authors
found that, breast disorders of both benign and malignant nature were
exceedingly higher in females. Malignant breast lesions were seen in women
with advanced age. Of note, there were many patients who came late to the
health facility seeking medical investigation. Therefore, enhancement of
community awareness regarding breast disease and implementation of screening
programs are needed in order to ameliorate morbidity and mortality.
The abstract; is structured abstract.
In the introduction; the authors specify the magnitude of the problem (Based on
the high demand for cytopathological examination requests and the day-to-day
clinical 
experience of physicians in the country, both the prevalence and incidence of
breast cancer are steadily increasing in Eritrean women).
Methodology of the study are clear (study setting and study design, study period
and study participants, laboratory methods, inclusion and exclusion criteria and
data collection and processing).
In the discussion section; the authors compared their findings by the relevant
previous studies.
In addition; they mentioned the limitation, the strength of their study and the
future recommendations. 
Tables are clear and informative for me.
The refences are recent and relevant for the research title.
Finally; the manuscript is excellent and can be accepted for publication without
suggested changes or corrections from my side.
Regards 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
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 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:
Acceptable
Declaration of competing interests
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