Reviewer's report
Title:Clinical pattern and spectrum of endometrial pathologies in patients with
abnormal uterine bleeding in Pakistan: need to adopt a more conservative
approach to treatment.
Version:2Date:28 March 2014
Reviewer: Cyril Dim
Reviewer's report:
These revisions are Minor essential!
Authors have made fair attempt at revising the manuscript in line with my earlier
comments. However, some recommendations were not properly addressed.
Specific comments:
Sticky notes comments: Authors should review all sticky notes posted in my
earlier comments especially in Result section. I had suggested some revisions to
make the results clearer but it appears authors did not accept them. I suggest
they look at them again.
Abstract:
I note that authors had shortened the background section of the abstract and
effected the recommended corrections. They may consider shortening the
conclusion as suggested in my first review.
Introduction:
Authors have made substantial revision to this section. They should still note the
following:
• Paragraph 1, lines 2-4: report(s) from their locality on the prevalence of AUB
(e.g. per gynae. clinic attendee).
It appears authors could not identify any report on AUB prevalence in their area;
if that is the case, they should revise the opening statement of the Result so as to
indicate the prevalence of the AUB in the study center for eg. “Within the study
period, there were 300 AUB cases out of 1000 gynaecological cases which gave
an AUB prevalence of 30 AUB per 100 gynaecological cases. Out of the 300
AUB cases, 241 (80.3%) participants were recruited into the study. ……”
• Para 4, lines 2-3: “…..which dilatation and curettage is considered …….”.
Provide a reference for this statement.
It seems authors could not find a reference to support this assertion which made
them to delete it in the revised manuscript. I suggest that they re-introduce the
example without a reference thus: “Since endometrium is the best
……….bleeding, several methods can be used for endometrial sampling such as
Dilatation and Curettage.”
Methods:
This section has improved tremendously and I commend the authors. However,
authors should note the following comments that need further clarification.
• Sampling: Were the study participants selected consecutively or a sample of
patients. If the latter, what method was used?
It appears sampling was consecutive so, authors should state it clearly.
• What was your primary outcome measure(s)? Was the sample size adequate to
measure it (then), and how did you determine your sample size?
Authors have not addressed this comment and I strongly feel that it is necessary!
From the manuscript, it appears that their primary outcome measure was the
“prevalence of endometrial pathologies in the study population” I hope this helps
authors to address the comment on sample size.
• Who carried out the D & C? What training does s/he have? Is he blinded to
study’s objectives? Summarize what was done and how the specimen was
handled. For instance, “D and C was carried out by 2 gynaecologists using
standard method (insert reference). For each participant, her specimen was
immediately stored in Formalin solution (state the solution used and
concentration), labeled, and transferred to the histopathology laboratory”
Authors responses to the above comments are noted however, they should
indicate whether the gynaecologists were blinded to the studies objectives or
not?
Also, they should provide reference for the standard method used for the D&C.
This will ensure reproducibility of the study.
• Quality control for the histology reports: Who reported the histology slides?
Were they blinded to study objectives? How did you ensure quality control so as
to reduce measurement bias during the reporting? If no measure was put in
place, authors should discuss this limitation and the possible effect on the
results.
Authors have not addressed this concern completely and I encourage them to do
so. For instance, I expect that at least 2 independent pathologists (blinded to the
studies objectives) should review each slide and when there is a discordance, a
third pathologist comes in as a tie breaker. This is a good measure to reduce
measurement bias which can be substantial when one pathologist decides on a
slide.
• Key terminologies were used in this study such as polymenorrhea, etc. Authors
should state the definition they used for each term with reference(s).
Authors placed these definitions at the end of the manuscript. They should
transfer them to end of Methods section.
Results:
• Authors should provide the prevalence of AUB at the study center during the
study period as suggested above (Introduction).
Authors should revise the opening statement of the Result so as to indicate the
prevalence of the AUB in the study center for e.g. “Within the study period, there
were 300 AUB cases out of 1000 gynaecological cases which gave an AUB
prevalence of 30 AUB per 100 gynaecological cases. Out of the 300 AUB cases,
241 (80.3%) participants were recruited into the study. ……”
• Para 2, lines 1-3: When more than 1 denominator is involved in a report, it may
be better to indicate them for better clarity. E.g. " Among the 82 (34.0%) cases
with normal menstrual pattern, secretory endometrium was the commonest
pattern (59.8%, 49/82), followed by proliferative endometrial pattern (40.2%,
33/82).
It appears authors did not accept this and some other recommendations within
this section. Authors should review the comments in the sticky notes sent earlier.
• Uniform presentation of percentages (one decimal place) is encouraged
Discussion
Authors should comment on their study’s strength and limitations and new
research interests based on their study.
Conclusion should be concise and based on the results. Also, authors can make
policy-relevant recommendation(s) based on their results.
Tables and Figures
Table1:
Please, refer to my earlier comment. Add a row at the end of table 1 to indicate
"Total" of sub-categories presented.
Present your percentages using one decimal place
Figures (Charts):
Please delete figure 3 in the revised manuscript.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests