Reviewer’s report
Title: 
The effects of Saline Infusion Sonography on the histological quality of
endometrial sampling in women with postmenopausal bleeding
Version: 
2 
Date: 
03 Jan 2023
Reviewer's report:
I believe this paper entitled, "The effects of Saline Infusion Sonography on the
histological quality of endometrial sampling in women with postmenopausal
bleeding," evaluates a very important clinical question that often is raised. After
performing saline infusion sonohysterography when there is global tissue can
one immediately perform endometrial sampling with a suction piston biopsy
sampling instrument and be assured that one is getting reliable tissue. This
prospective, randomized, crossover-type study very nicely demonstrates that the
histology performed after sonohysterography is, in fact, reliable. This has
important clinical ramifications. I found, however, the nomenclature to be
somewhat cumbersome and confusing, especially their analysis of sufficient
versus insufficient tissue in Table 3 as well as its description in the text itself.
The purpose of the study is to compare parameters of sufficient to sufficient pre-
and post- SIS as well as insufficient to insufficient pre- and post- SIS. The
comparison of sufficient versus insufficient, in general (Table 3), does not
belong in this paper and merely lengthens it and is somewhat confusing to me as
a reader. 
If the authors feel this is important clinical information, then perhaps a separate
report would be indicated. 
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Is the study design appropriate to answer the research question (including the use
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presented?
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from apparent manipulation?
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No