Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results in Breast Cancer Patients Treated with Radiotherapy
Round 1
Reviewer 1 Report (Previous Reviewer 1)
Without comments
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
The article is very interesting and describes an important health problem. The publications cited are aptly selected. Results presented correctly
I have very few comments - rather technical:
In the introduction, describe epidemiological data on the incidence of breast cancer in Turkey. In the method: Describe how the sample size was calculated (control group and case group) I would add in what statistical program the statistical tests were performedConclusion: Please underline why this article is publishable, which is innovative.
Future research directions may also be mentioned.
I would add:
The Abbreviations:
Institutional Review Board Statement:
Informed Consent Statement:
Data Availability Statement:
Author Response
Response to Reviewer 1 Comments
Many thanks for your didactic and comprehensive evaluation of the manuscript. Below, you will find our responses:
Point 1. In the introduction, describe epidemiological data on the incidence of breast cancer in Turkey.
Response 1: As per your suggestion, the relevant sentence has been added to the introduction section.
- “The incidence rate of female breast cancer in Turkey is 46/100000. One in every four cancers in women is breast cancer, and 42% of breast cancer cases are in the 15-49 age group.“
Point 2. In the method: Describe how the sample size was calculated (control group and case group)
Response 2:
Dear Reviewer, first of all, thank you for your evaluation. Our study was designed retrospectively. All female patients who met the inclusion and exclusion criteria between 2007 and 2021, who had MPS in our center, whose records we could access from the hospital automation system or the patient data file, were included in our study. As per your suggestion, the relevant sentence has been added to the study population section to explain the patient selection in more detail.
“All patients who met the inclusion and exclusion criteria and underwent CAG in our center for MPS positivity between 2007-2021 were included in our study. “
Point 3. I would add in what statistical program the statistical tests were performed.
Response 3: As per your suggestion, the relevant sentence has been added to the Statistical Analysis section.
“The statistical analysis of the data was conducted using version 26.0 of the SPSS software (SPSS Inc, Chicago, Illinois).”
Point 4. Conclusion: Please underline why this article is publishable, which is innovative
Response 4: As per your suggestion, the relevant sentence has been added to the conclusion section.
Our study found that the sensitivity of the MPS test was significantly lower in the RT group; It is valuable in terms of showing that coronary angiography performed according to the MPS test result or reperfusion strategy decisions to be taken in this direction may be incorrect.
Point 5. Future research directions may also be mentioned.
Response 5: As per your suggestion, future research directions has been revised
Point 6. I would add:
The Abbreviations:
Institutional Review Board Statement:
Informed Consent Statement:
Data Availability Statement:
Response 6: As per your suggestion, the relevant sections have been added.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Thank you very much for the opportunity to review an manuscript entitled „Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results in Breast Cancer Patients Treated with Radiotherapy”. Even thus, this article is in a recent subject of interest in nuclear medicine, it has some major flaws, which should be changed before accepting for publication.
1. In the whole manuscript please provide changes of the nomenclature in whole manuscript according to "Consensus nomenclature rules for radiopharmaceutical chemistry — setting the record straight”.
2. Authors did not provide the results for MPS or CA in the main test, and this should be included when Authors write about comparison of MPS and CA.
3. The major flaw of this manuscript is a significant diference in number of patients included in this study, which might have a significant influence on the obtained results. If Authors hass uch a big data the ‘control group’ should not be twice bigger comapred to the first one.
4. Authors should provide the information about the data fir brest cancer patients for example: stage of the disease
5. There is no description about radiotherapy protocol and radiotherapy technique – does patients were treated by VMAT? With Boost? This information is highly important and must be added.
6. Does patients laboratory test were performer before or after the treatment, when patients were reffered to MPS?
Author Response
Response to Reviewer 2 Comments
Many thanks for your didactic and comprehensive evaluation of the manuscript. Below, you will find our responses:
Point 1. In the whole manuscript please provide changes of the nomenclature in whole manuscript according to "Consensus nomenclature rules for radiopharmaceutical chemistry — setting the record straight”.
Response 1: As per your suggestion, manuscript has been revised
Point 2. Authors did not provide the results for MPS or CA in the main test, and this should be included when Authors write about comparison of MPS and CA.
Response 2: As per your suggestion, the result section have been revised and relevant sentences have been added.
“In the MPS results of the control group, RCA and Cx fields were higher in ischemic area localization.”
“Among patients in the RT group who underwent CAG, 32.5% had epicardial coronary artery stenosis of 60% or less. This rate was 11.5% in the control group.”
Point 3. The major flaw of this manuscript is a significant diference in number of patients included in this study, which might have a significant influence on the obtained results. If Authors hass uch a big data the ‘control group’ should not be twice bigger comapred to the first one.
Response 3: Dear Reviewer, first of all, thank you for your evaluation. Our study was designed retrospectively. All female patients who met the inclusion and exclusion criteria between 2007 and 2021, who had MPS in our center, whose records we could access from the hospital automation system or the patient data file, were included in our study. As our study was retrospective, no patients who met the relevant study criteria were excluded.
Point 4. Authors should provide the information about the data fir brest cancer patients for example: stage of the disease
Response 4: Dear Reviewer, There was no significant difference between cancer stages and MPS outcomes or RT dose regimens. As per your suggestion, the data is shown in table 1 and table 2 and stated in the article.
Point 5. There is no description about radiotherapy protocol and radiotherapy technique – does patients were treated by VMAT? With Boost? This information is highly important and must be added.
Response 5: As per your suggestion, the data has been added to the Table 1.
Point 6. Does patients laboratory test were performer before or after the treatment, when patients were reffered to MPS?
Response 6: Dear Reviewer, first of all, thank you for your evaluation. laboratory tests were performed based on the cardiology guidelines of the patients who applied to the cardiology clinic with the complaint of angina, and these are listed in Table 1. These lab test results were pre-MPS and patients were referred to MPS based on these results. As you stated, the time of these test results was not clearly written in the article. As per your suggestion, the relevant sentence has been revised.
“Socio-demographic, pre-MPS laboratory results, echocardiographic, angiographic, and RT and cardiac area radiation exposure data of 660 patients included in the study were recorded from the hospital automation system.”
Author Response File: Author Response.docx
Reviewer 3 Report
I like your manuscript very much. The idea is innovative and the content is clear. You have analyzed all relevant aspects of the topic with the appropriate statistical methods, and in the discussion you have explained point by point the results obtained. I have no changes to suggest.
Author Response
Response to Reviewer 3 Comments
I like your manuscript very much. The idea is innovative and the content is clear. You have analyzed all relevant aspects of the topic with the appropriate statistical methods, and in the discussion you have explained point by point the results obtained. I have no changes to suggest.
Many thanks for your didactic and comprehensive evaluation of the manuscript. Sincerely yours
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
1. How Authors know that patients did not develop some cardiac issues during the follow-up period, which are not related with the radiotherapy? Authors did not performed any imaging before radiotherapy in those patients, thus it is hard to exclude that some of them already had some cardiac issues, but they were silent.
2. Results section, table 1: Why Authors did not add the information about stage of the disease for patients from control group? Ando perform a statistical analysis comparing these two variables? Additionally, I would recommend to add the TNM stage as well.
3. Results section, table 1: There is no explanation of MPS in abbreviation section under the table. Moreover, in the table there is “IMAT”, whereas in abbreviations section “IMRT”. The same for “VMRT”.
4. Even thus, Authors provided in the text the sentence that “In the MPS results of the control group, RCA and Cx fields were higher in ischemic area localization.” This results should be presented in the table.
5. The major flaw of this manuscript is a significant difference in number of patients included in this study, which might have a significant influence on the obtained results. If Authors has such a big data the ‘control group’ should not be twice bigger compared to the first one.
