Reviewer’s report  
 
Title: Feasibility of endometrial sampling by vaginal tampons in women with Lynch syndrome  
 
Version: 1 Date: 07 Dec 2019  
 
Reviewer: Emma Crosbie  
 
Reviewer's report:  
 
Thanks you for submitting your revised manuscript, which  I think addresses all the comments 
raised by the two reviewers, with the exception of one. You have amended the sentence in the 
introduction that suggests that gynaecological surveillance is useful for women with Lynch 
syndrome to this:  
 
"Women with LS th erefore benefit from annual surveillance to detect endometrial abnormalities 
at earlier premalignant or early malignant stages [8 -12]. However, this does not improve survival 
[13]."  
 
This is important because of the uncertainty of the benefit of gynaecolog ical surveillance in 
Lynch syndrome according to the Manchester International Consensus Group and other expert 
groups. However, I still think it's a bit misleading and would recommend the following sentence 
instead:  
 
"Women with LS may therefore benefit fr om annual surveillance to detect endometrial 
abnormalities at premalignant or early malignant stages [8 -12]. However, this has not been 
shown to improve survival [13]."  
 
I have added the word 'may' to the first sentence because I still do not believe the e vidence is 
there to say surveillance definitely does benefit women with Lynch syndrome. I have also taken 
out the word 'earlier' from this sentence because there has been no RCT to compare women with 
Lynch syndrome undergoing/ not undergoing surveillance, so we cannot say the abnormalities 
are picked up at an earlier stage, just that they are picked up at an early stage. And in the second 
sentence I have added uncertainty to your statement about survival because the hope is that 
gynaecological surveillance does, in fact, confer a survival benefit, it's just that we haven't shown 
it yet.  
 
If you make these changes, I think the manuscript is now suitable for publication. Thank you.  
 
 
 
 
 
 
 
 
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimburse ments, 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 organi zation that 
holds or has applied for 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 am interested in non -invasive sampling for endometrial cancer detection and Lynch syndrome -
associated endometrial cancer.  
 
I agree to the open peer review policy of the journal. I understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
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CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be p ublished.  
 
I agree to the open peer review policy of the journal