Reviewer's report
Title:Surgical margins in conization by Large Loop (LLETZ) and Straight Wire
Excision of the Transformation Zone (SWETZ): a randomized study.
Version:3Date:30 September 2014
Reviewer: Dimitrios Papoutsis
Reviewer's report:
Dear Editor,
Thank you for giving me the opportunity to review this very interesting article.
Indeed, many researchers are trying to identify new excisional techniques that
will be superior in terms of delivering less morbidity to the patient and that will
reduce the risk of CIN recurrence at follow-up by eliminating some risk factors,
such as having a less percentage of endocervical margin involvement.
I believe this article can be accepted for publication pending several major
changes are made.
Please note the following:
Minor changes:
English language: The authors will need to improve the language in several parts
of the manuscript, for example:
Abstract (background), line 310, 318-319 etc.
Inappropriate reference-please change: line 100-reference 2.
Major changes:
Material and Method:
1) The study time period has not been mentioned.
2) Line number 174 (description of SWETZ): How was hemostasis achieved at
the end of procedure? Was ablation done in the crater of cervix?
3) How many surgeons (colposcopists) were doing the excisional procedures and
what was the level of their experience as they had some very serious
complications leading to hysterectomy? Were the results practitioner dependent
and could the experience have introduced a bias in the results?
4) Please mention if patients gave you their informed consent.
5) Line 169: Why did you set as an objective to remove 20-25 mm in depth and
not anything less?
6) Line 174: 1 cm length straight electrode and 0.2 of straight section….. . My
question is 0.2 of what?
7) Please remove all youtube video url addresses !!!!
Results:
1) Table 4 and Table 5 do not need to be included. The description in the text is
enough.
Discussion:
1) Line 313: how was cervicometry performed?
2) Line 328: Please provide any literature reference for the shrinkage of tissue
samples after fixation with formalin.
3) The discussion section has 12 paragraphs. Please limit the number of
paragraphs by integrating some in one paragraph.
4) What are the strengths and limitations of your study? Please clarify.
5) I would like to have seen a comment on the depth of cones and oncologic
versus obstetric risk as some patients in the study were of reproductive age.
Perhaps a subgroup analysis for women under 45 years old would have been
useful to see if SWETZ is also a superior technique for them without leading to
such deep cones and therefore exposing them to a future obstetric risk.
6) If the mean depth between SWETZ and LLETZ is the same (see Table 2), how
do the authors explain the finding of less positive endocervical margins with
SWETZ technique? Have these results been adjusted for specimen
fragmentation as a confounder?
7) Do you have any information on the cytology follow-up of these patients
treated with SWETZ versus LLETZ at 6 months and 12 months to see if the
failure rate is the same or different?
References:
Only 11 references have been provided. I would have expected many more in
such an article.
Please provide more references (if any) on the following:
1) NETZ versus LLETZ (line 121)
2) CKC versus LLETZ (line 182).
Overall impression:
The idea is original, nevertheless the findings can be better presented and more
references added. Also, discussion can be widely reformatted to better support
the findings.
Kind regards.
Dr Dimitrios Papoutsis, MD, MSc, PhD
United Kingdom
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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.