Performance of Indocyanine Green Compared to 99mTc-Nanocolloids for Sentinel Lymph Node Detection in Early Vulvar Cancer

Round 1

Reviewer 1 Report

(1)  Were SLNs sent for intraoperative frozen section?

(2) What was the detection rate of SLN in those patients who had previous vulvar surgery?

(3) How many SLNs were above (i.e., the superficial group) and below (i.e., the deep group) the cribiform fascia, respectively?

(4) In Table 2, why did the detection rate by the modality of “Radioactivity or fluorescence” lower than either “Radioactivity” or “Fluorescence”?

(5) In the Materials and Methods section, “our protocol consisted in injecting 4 mL of ICG at 2 points” should be mentioned. In addition, what is the concentration of ICG in the current series?

(6) Is there any isolated tumor cells in the SLN?

(7) In page 4, the “Associated Lesion” of Table 1 did not complete the spelling of lichen sclerosus.

(8) In Table 2, “Detection rate intra-operative per patient” should be intra-operatively detected SLN numbers per patient, and “Detection rate intra-operative per patient” should be intra-operatively detected SLN numbers per groin.

(9) In Table 2, what did the “n SLN” and two “n Patientes” stand for?

(10) In Table 2, “negatif” and “patientes” are spelling error

Author Response

Dear Editors

Dear Reviewers

Thank you for considering our work.

We modified the text according to comments. Changes are shown in red and blue (for grammatical errors).

We hope that you will find the current version improved.

Kind regards

REVIEWER 1.

(1)  Were SLNs sent for intraoperative frozen section? No

(2) What was the detection rate of SLN in those patients who had previous vulvar surgery?

In the sub-group of patients who had previous vulvar surgery, the sensitivity of ICG was 87.5%. The ICG PPV for sentinel lymph node detection was 93.3%.

(3) How many SLNs were above (i.e., the superficial group) and below (i.e., the deep group) the cribiform fascia, respectively? This distinction was not recorded.

(4) In Table 2, why did the detection rate by the modality of “Radioactivity or fluorescence” lower than either “Radioactivity” or “Fluorescence”? it’s a grammatical error, the correct  is “radioactivity and fluorescence”

(5) In the Materials and Methods section, “our protocol consisted in injecting 4 mL of ICG at 2 points” should be mentioned. In addition, what is the concentration of ICG in the current series?

The ICG injection was performed in the operating room by the surgeon, under general anesthesia, after skin disinfection and before starting vulvectomy. The ICG ampoule contained 10ml with 25 mg. After dilution in 10mL of glucose serum, the ICG was injected near the vulvar lesion, at 2 points, subcutaneously or superficially, 1 ml then 1 ml deeper, at a rate of 2 ml, or 2.5 mg per point.

(6) Is there any isolated tumor cells in the SLN? No

(7) In page 4, the “Associated Lesion” of Table 1 did not complete the spelling of lichen sclerosus. corrected

(8) In Table 2, “Detection rate intra-operative per patient” should be intra-operatively detected SLN numbers per patient, and “Detection rate intra-operative per patient” should be intra-operatively detected SLN numbers per groin. corrected

(9) In Table 2, what did the “n SLN” and two “n Patientes” stand for? corrected

(10) In Table 2, “negatif” and “patientes” are spelling error corrected

Reviewer 2 Report

I read with great interest the Manuscript titled "Performance of indocyanine green compared to 99mTc-nanocolloids for sentinel lymph node detection in early vulvar cancer" which falls within the aim of the Journal. In my honest opinion, the topic is interesting enough to attract the readers’ attention. Methodology is accurate and conclusions are supported by the data analysis. Nevertheless, authors should clarify some point and improve the discussion citing relevant and novel key articles about the topic.

- Abbreviations and grammatical errors in the manuscript should be revised and corrected.

-Although it is a retrospective analysis, Inclusion/exclusion criteria should be better clarified by extending their description.

- Discussions can be expanded and improved by citing relevant articles (I suggest authors to read and insert in the references the following articles PMID: 33306289; 34962334). Considered all this points, I think it could be of interest for the readers and, in my opinion, it deserves the priority to be published after minor revisions.

Author Response

Dear Editors

Dear Reviewers

Thank you for considering our work.

We modified the text according to comments. Changes are shown in red and blue (for grammatical errors).

We hope that you will find the current version improved.

Kind regards

REVIEWER 2

I read with great interest the Manuscript titled "Performance of indocyanine green compared to 99mTc-nanocolloids for sentinel lymph node detection in early vulvar cancer" which falls within the aim of the Journal. In my honest opinion, the topic is interesting enough to attract the readers’ attention. Methodology is accurate and conclusions are supported by the data analysis. Nevertheless, authors should clarify some point and improve the discussion citing relevant and novel key articles about the topic.

- Abbreviations and grammatical errors in the manuscript should be revised and corrected. We tried to correct some errors.

-Although it is a retrospective analysis, Inclusion/exclusion criteria should be better clarified by extending their description.

The inclusion criteria were an age superior than 18 years and an early clinically and radiologically stage (T1-T2, N0 M0). All histologic types were included, except sarcomas. Patients who did not benefit from dual detection by TC and ICG, pregnant or breastfeeding women or with an allergy to ICG were excluded.

- Discussions can be expanded and improved by citing relevant articles (I suggest authors to read and insert in the references the following articles PMID: 33306289; 34962334). Considered all this points, I think it could be of interest for the readers and, in my opinion, it deserves the priority to be published after minor revisions.

These studies are now cited before the conclusion.