Reviewer’s report
Title: 
BREAST CANCER IN TOGOLESE
WOMEN:IMMUNOHISTOCHEMISTRY SUBTYPES
Version: 
0 
Date: 
14 Sep 2020
Reviewer's report:
The article provides useful information on the IHC results for Togolese patients.
There are a number of grammatical errors in the article and a review of the
English would be useful.
The cut offs used for reporting positive and negative ER and PR are not the
standard cutoffs. The definition for ER and PR positivity is usually >1% whereas
the article uses 10%. This may account for differences in the subtype
classification. The data can be subdivided if necessary, into a group of 1-10% if
this is considered useful. HER2 IHC is also divided into 0, 1+ as negative, 2+ as
equivocal and 3+ as positive and this is not defined in the definition, but Table 2
lists a HER2 category as equivocal. This should be clarified. ISH is not required
if it is not available. There are updated ASCO guidelines for the reporting of
HER2 positivity in breast cancer and this should be updated
https://ascopubs.org/doi/full/10.1200/JCO.2018.77.8738.
One of the main issues is the omission of the data for the patients where IHC was
not performed. This may introduce significant bias into the survival data and the
classification. There also needs to be a discussion on why those patients had IHC
performed. Was IHC performed for more advanced disease, younger patients etc
which may skew the results of the study and introduce a bias into the survival
data? It is mentioned that IHC was limited because of unavailability and cost but
were the patient demographics the same between those who had IHC and those
who did not. Whilst it will not be possible to stratify the patient subgroups with
IHC into TNBC etc, the tumour grade, stage etc can be compared between the
groups to see if there is a bias in the testing with selection of specific patient
subgroups for IHC testing eg younger patients. There may also be a bias in the
section of tumour type or grade for IHC testing. This may account for the higher
proportion of TNBC patients in combination with the higher cutoff used for
defining ER/PR positivity.
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