Side Bioimpedance Analysis in Menopausal Post-Oncological Breast Cancer
Round 1
Reviewer 1 Report
The manuscript “Side Bioimpedance analysis in breast cancer” reports comparing the results of side bioimpedance analysis of patients subjected to quadrantectomy and mastectomy in menopause and the control group of apparently healthy women of childbearing age. The authors found that, in general, the patients had higher free fat index and brachial circumference values than those of the control group. The parameters of patients depending on the hemisphere undergone surgery were also studied.
Despite the fact that the topic of the paper is extremely important, it cannot be recommended for publication without major revision.
First, it is not entirely correct to compare the results for menopausal patients with those of the control group in a fertile state. In addition, it is doubtful to compare data for younger patients after mastectomy and older patients after quadrantectomy. For example, an increase in the brachial circumference values may be caused by a worse physical condition due to more advanced age, but also due to indifference to one's physical form associated with the awareness of the disease. The authors should not be silent about these points and express their ideas as a difference in the physiological age and stage at which the woman was subjected to surgery can have a side effect in processing the results.
The method contains references to the description of bioimpedance analysis but it is necessary to provide at least a brief description of its mechanism. Research results are poorly visualized. It is desirable to provide an analysis scheme, i.e. the position of the woman and the exact location of the electrodes. It will also be more convenient for the perception of information to depict the division of women into groups depending on the area of surgery and to compile data for the right and left hemispheres.
Statements related to the assessment of the impact of the implant are not confirmed by any analysis, so they arise unexpectedly and unreasonably. Authors must provide either some experimental evidence or exclude such claims.
Please double check misprints and grammar mistakes, there are a few of them.
Author Response
REVISORE 1
The manuscript “Side Bioimpedance analysis in breast cancer” reports comparing the results of side bioimpedance analysis of patients subjected to quadrantectomy and mastectomy in menopause and the control group of apparently healthy women of childbearing age. The authors found that, in general, the patients had higher free fat index and brachial circumference values than those of the control group. The parameters of patients depending on the hemisphere undergone surgery were also studied.
Despite the fact that the topic of the paper is extremely important, it cannot be recommended for publication without major revision.
We want to thank the reviewers for giving us the opportunity to improve the manuscript and to ameliorate the comprehension and the interest for readers . All the suggestions have ben accepted and the modifications requested have been made.
First, it is not entirely correct to compare the results for menopausal patients with those of the control group in a fertile state.
We thank for this observation that offers us the possibility to clarify this point . Despite the different age of the groups analyzed , however we respectfully underline that the control group is composed of women aged aged 46.5 ± 13.44 years ( from 46 up to 59 yrs) – and therefore in a range of the perimenopausal- menopausal time ( only 3 cases were in the fertile staus) , not substantially different from the BC group aged since 56.6 up to 64 years. We believe that this a group of women cannot be considered in a childbearing age . This aspect has been clarified in deep in the text and the details of the data collection have been explained . Following your suggestions we have modified the text in the material session and discuss this aspect as a potential limit of the study . The title could be also modified following your kind observation .
In addition, it is doubtful to compare data for younger patients after mastectomy and older patients after quadrantectomy. For example, an increase in the brachial circumference values may be caused by a worse physical condition due to more advanced age, but also due to indifference to one's physical form associated with the awareness of the disease. The authors should not be silent about these points and express their ideas as a difference in the physiological age and stage at which the woman was subjected to surgery can have a side effect in processing the results.
Thank you for this observation, however We do not understand exactly what do you mean. The text reports data of The mastectomy patients (54,7 ± 8,8 years, BMI 23,7 ± 3,5 Kg/m²) and …. quadrantectomy (57,8 ± 9,9 years; BMI 27,5 ± 4,1 Kg/m²). We believe they can be considered similar. Regarding the potential role of the awareness of the disease and also of the kind of the surgical treatment , we are in agreement with you. This is the crucial poin of the study and the aim of the results. In any any case , from this pilot study, the data support the mastectomy is associated to a better body composition if compared to quandrantectomy . This aspect has been discussed in the conclusions. It could be reasonable to hypothesize that a more invasive surgical treatment induces a stronger awareness of the clinical status and therefore a stronger response in terms of lifestyle habits .
The method contains references to the description of bioimpedance analysis but it is necessary to provide at least a brief description of its mechanism. Research results are poorly visualized. It is desirable to provide an analysis scheme, i.e. the position of the woman and the exact location of the electrodes.
Thank you for his suggestions , more details of the BIA analysis has been insert . An additional reference has been insert .
It will also be more convenient for the perception of information to depict the division of women into groups depending on the area of surgery and to compile data for the right and left hemispheres.
We respectfully underline that the design of the study has been made following this scheme . …. In first line, the body composition of post oncological patient was compared with the control group and then, the group of cases was further subdivided according to the type of surgery
Statements related to the assessment of the impact of the implant are not confirmed by any analysis, so they arise unexpectedly and unreasonably. Authors must provide either some experimental evidence or exclude such claims.
We are in agreement with you. This is just an hypothesis . This statement has been modified in the text .
Please double check misprints and grammar mistakes, there are a few of them.
The English version has been corrected
Reviewer 2 Report
This paper describes bioimpedance and anthropometric results from a small group of women who have been treated for breast cancer, and a control group. This topic is of interest to many in this field where good quality data are required.
The selection of patients and data collection have been done appropriately. Unfortunately, the authors have performed far too many t-tests, making the interpretation of the results very difficult.
As a recommendation, the authors should rewrite the manuscript focussing on their "best" result, namely:
"...quadrantectomy , although considered conservative and involving the removal of only one breast quadrant, is apparently associated with bioimpedance parameters at higher cardiovascular risk. This represents the most original aspect emerged from this study and not investigated before in literature. "
In addition, the authors should consider including the per-patient data in a supplement.
Author Response
This paper describes bioimpedance and anthropometric results from a small group of women who have been treated for breast cancer, and a control group. This topic is of interest to many in this field where good quality data are required.
The selection of patients and data collection have been done appropriately. Unfortunately, the authors have performed far too many t-tests, making the interpretation of the results very difficult.
As a recommendation, the authors should rewrite the manuscript focussing on their "best" result, namely:
"...quadrantectomy , although considered conservative and involving the removal of only one breast quadrant, is apparently associated with bioimpedance parameters at higher cardiovascular risk. This represents the most original aspect emerged from this study and not investigated before in literature. "
Thank you for this suggestion that offer us the opportunity to reduce the length of the paper . However this suggestions is in contrast with the other reviewers , For him the details of the groups analysed , subdivided in additional groups for comparing the differences of the surgical treatment , in not sufficient . We want to to highlight your suggestion including this strong evidence in the discussion
In addition, the authors should consider including the per-patient data in a supplement.
The per- patients data are available from the data collection of the ambulatory setting , where the study has been performed as declared in the text and in the consent form . Let me know if you need an anonymous excel format .In any case we respectfully underline that it could be too havy .
Round 2
Reviewer 1 Report
The clarifications and corrections made by the authors are convincing enough to recommend the manuscript for publication.
