Reviewer ’s report  
 
Title: Predictors of abnormal cytology among HPV -infected women in remote territo ries of  
French Guiana  
 
Version: 0 Date: 04 Jul 2017  
 
Reviewer: Jane Shen -Gunther  
 
Reviewer's report:  
 
Title:  Predictors of abnormal cytology among HPV -infected women  in remote territories of 
French Guiana  
 
 
 
ABSTRACT OF MANUSCRIPT (SUMMARIZED BY REVIEWER)  
 
 
- Objective: identify factors associated with abnormal cytology in HPV -infected women in 
remote regions of French Guiana.  
 
 
- Design: prospective, cross -sectional stu dy 
 
 
- Data collection:  December 2012 through September 2014. Prospective data and sample 
(cytology and HPV DNA) collection from 601 women aged 25 -65 years undergoing 
routine cervical cancer screening.  
 
 
- Data analysis:  crude odds ratios and multivariate logistic regression were used to identify 
predictors of binarized outcome (normal or abnormal cytology).  
 
 
- Data interpretation: identification of predictor variable(s), i.e. demographic 
characteristic s and/or HPV genotypes associated with abnormal cytology.  
 
 
COMMENTS  
 
1. Overall quality of manuscript: needs extensive language editing.  
 
a. Recommend a scientific writer to review and edit the manuscript for grammar, sentence 
structure and word choice; t he manuscript also lacks sufficient detailed information for the 
readership.  
2. Background Section.   
 
a. This section requires editing for clarity and flow of information.  For example (page 5, lines 
18-28), "Vaccination against HPV is now recommended in  French Guiana" should be deleted; 
"Opportunistic screening…" should be revised as, "Current screening practice in French Guiana 
is annual cervicovaginal cytological testing in women aged 25 -65 years of age."  Also, "…the 
HPV test is only reimbursed…" may be edited as follows, "Primary HPV testing is not standard 
practice, instead it is performed after an abnormal cytology result."   
 
 
b. Rationale and significance of the study needs to be emphasized in the last sentence of this 
section (page 5, line 39).  
 
 
 
3. Methods Section.  
 
a. The Methods Section and subheadings (page 5, line 42 through page 7, line 32) should follow 
the format provided by BM C Women's Health 
(https://bmcwomenshealth.biomedcentral.com/submission -guidelines/preparing -your-
manuscript/research -article ). 
 
The authors are recommended to view a recently published manuscript in BMC Women's 
Health, "Effects of peer health education on perception and practice of screening for cervical 
cancer among urban residential women in south -east Nigeria: a before  and after study" - 
 
Mbachu C, Dim C, Ezeoke U. BMC Womens Health. 2017 Jun 9;17(1):41. doi: 10.1186/s12905 -
017-0399 -6. 
 
 
b. Design: prospective, cross -sectional study.  
 
 
c. The authors use prospectively collected data from December 2012 through September 2014 .   
 
 
d. The data covers the results of diagnostic tests from 601 women.  
 
 
e. Commercial test used: GREINER -BIO-ONE kit for HPV DNA detection.   
 
 
i. Comments:  the GREINER -BIO-ONE laboratory methods should be described in detail. For 
example: the types of prime r sets, PCR cycling conditions, definition of positive or negative test 
according the manufacturer. Also, the analytical sensitivity and specificity needs to be described. 
The cervical cytology sampling and testing method, i.e. conventional cytology (Pap s mear 
slides), liquid -based cytology, Thin -Prep automated screening or manual visual screening should 
be described.  
 
 
f. Statistical Section (page 7):   
 
 
i. Crude odds ratios and multivariate logistic regression were used to identify predictors of 
binarized o utcome (normal or abnormal cytology).  
 
 
ii. Comments/Suggestions: Power analysis was not described. This needs to be documented.  
 
 
g. Tables and Figures:  in general, logical layout and straightforward.  
 
 
i. Comments/Suggestions:  Table 1 column headings, bot h columns are labeled as "cytology 
positive" - the column on the left should be "cytology negative." Also, cytology samples should 
be integers and does not require decimal points. For the OR column, the 1.00 is preferably 
labeled as "referent." Table 3, fi rst column with HPV species and genotype, the heading should 
be labeled "HPV species (genotypes)" for clarity. Figure 1, the HPV genotypes should be 
grouped by carcinogenic potential, i.e. carcinogenic, possibly carcinogenic, or not or 
unclassified.  
 
 
 
4. Results Section.  
 
a. The number of women with abnormal cytology (N=61) does not equal the number of 
cytological abnormalities listed (30 ASCUS, 7 ASCH, 18 LSIL, 7 HSIl, 3 glandular 
abnormalities [ N=65]) (Page 7, line 42 -44). This needs to be corrected.  
 
 
5. Discussion/Interpretation.  
 
a. Interpretation of the results may be biased due to 1) the small subset of subjects within each 
cytopathological category (30 ASCUS, 7 ASCH, 18 LSIL, 7 HSIl, 3 glandular abnormalities [ 
N=65]), and 2) higher numbers of ASCUS  versus other cytological categories. The HPV 
genotypes within each cytological category are different (see references below). However, the 
general conclusion that HPV genotype, in particular, carcinogenic HPV species and genotypes 
are associated with cyto logical abnormality is consistent with other published studies.  
 
 
b. Recommend the authors to use International Agency for Research on Cancer (IARC) 
terminology for HPV carcinogenic potential.  For example, HPV -53 is categorized as "possibly 
carcinogenic" r ather than "probably carcinogenic" (page 9, line 12 -17).  
 
 
c. Strengths and limitations are briefly discussed.  
 
 
d. Findings and concluding remarks address the original question of the study "what factors are 
associated with abnormal cytology in HPV -infected  women in remote regions of French 
Guiana." The findings do contribute new knowledge to the existing literature since women of 
French Guiana have been unstudied/understudied; however, a larger sample size with detailed 
information regarding the methodology  of the assay & its analytical performance is required to 
draw valid conclusions.   
 
 
 
SUGGESTED REFERENCES (FOR REVIEW AND/OR ADD TO MANUSCRIPT)  
 
 
Suggested Reference: Thomas A. Lang and Michelle Secic. Tabular Displays of Data and 
Statistics in How to Rep ort Statistics in Medicine, 2nd Ed., p327 -348.  
 
 
International Agency for Research on Cancer. IARC monographs on the evaluation of 
carcinogenic risks to humans —human papillomaviruses, volume 100B. Geneva: World Health 
Organization; 2012. p. 255 -313. 
 
 
A pop ulation -based study of human papillomavirus genotype prevalence in the United States: 
baseline measures prior to mass human papillomavirus vaccination. Int J Cancer. 2013 Jan 
1;132(1):198 -207. doi: 10.1002/ijc.27608. Epub 2012 Jun 20.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 applying 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 f or 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 yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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