Title: Tumor size and stage assessment accuracy of MRI and ultrasound versus pathological
measurements in early breast cancer patients
Version: 1 Date: 12 Feb 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The presented study compares the accuracy of ultrasound MRI
imaging in determining tumor size and stage in early breast cancer patients vs. pathological
measurements. The study concludes that ultrasound imaging is a reasonable and good first
choice for tumor size estimation and determination of the disease stage, especially in developing
countries. That is supported by the evidence that there were no significant differences between
findings from ultrasound and MRI.
The manuscript is well written and the authors have done a good job defining the study's
objectives. The study involves retrospective design with clear patient population description
and specific inclusion and exclusion criteria. The authors have provided detailed descriptions
of the imaging procedures, image analysis, and pathological assessments. They have applies
appropriate statistical methods for data analysis and have acknowledged limitations of their
study and offered reasonable explanations for their findings.
It should be noted that the retrospective design of the study is prone to selection bias. The authors
mention that pathological slides were not reviewed, which could introduce variability in the
results. That said, the authors acknowledge potential measurement bias due to measurements
being taken by radiologists instead of using CAD. The generalizability of the finding may be
limited by the specific context of a single center in China with experienced ultrasound experts.
The authors could improve the discussion section by providing a more in-depth discussion of the
clinical implications of using ultrasound as the primary modality, considering factors beyond
just concordance rates.
ADDITIONAL REQUESTS/SUGGESTIONS:
In the study, you emphasize the value of ultrasound imaging in developing countries like China,
especially given its cost-effectiveness. You should also include a discussion of how these
findings might apply to other healthcare systems with varying (potentially more) resources and
expertise levels.
In addition, please provide your insight to the following questions:
- How do you think the lack of a central pathology review might affect the consistency of
pathological measurements?
-  What methods did you use to account for or mitigate the effects of tumor shrinkage?
- How would different molecular subtypes affect the accuracy of ultrasound and MRI in tumor
size and stage estimation? How could this inform clinical decision-making?
I also suggest you further research to validate your findings by considering multi-center studies
with larger, more diverse patient populations.