Recent Advances in the Surgical Management of Thyroid Cancer
Round 1
Reviewer 1 Report
The authors have prepared an excellent work on the recent advances in the surgical management of thyroid cancer. The manuscript is well written, with very good use of English language. It includes a very well-prepared description of the surgical techniques (including the recent-most advances in the field), their complications and their outcomes. In addition a short, but comprehensive review of the current knowledge regarding the surveillance strategies in low risk tumors is present. Therefore, we feel that this work could be of great use to most interested parties.
Despite that, a few minor points warrant some attention:
1. Increasing rates of DTC are believed to be related mostly to the common use of POC ultrasound screening, but some studies relate it in part to the rising frequency of thyroid autoimmunity. Please add that to your introduction.
2. In section 2.3 Thyroid nodule molecular testing, please make a note of newer methods under development, arising from recent studies e.g. tumor microenvironment, immune cells etc.
3. In section 2.3 Thyroid nodule molecular testing please make a note on the unsatisfactory positive predictive values of commonly used tests and its impact on preoperative diagnosis.
4. In section 2.3 Thyroid nodule molecular testing lines 122-125 please note that the cost of diagnostic surgery vs molecular testing for the management of indeterminate nodules is clearly more cost-effective based on the US market values of these procedures.
5. Despite the recent eighth edition of the Union for International Cancer Control (UICC) tumor, node, metastasis (TNM) classification of malignant tumors (section 2.4) it is established that minimal ETE is associated with statistically significantly higher risk of recurrence, especially in the presence of lymph node involvement, even though not used in staging these tumors.
6. In the choice of surgical treatment for low risk DTC patients, the meta-analysis of Rodriguez Schaap is mentioned (lines 227-230), but this work is limited by the retrospective observational nature of all the studies meta-analyzed.
7. Similarly, the study (reference 34) of the group of JA Sosa is limited by the retrospective nature and the relatively short duration of follow up, given that the main outcome is mortality from low risk thyroid cancer. We feel that a mention should be added about the need for a long term prospective trial comparing the outcomes obtained with each type of operation, with regard to oncological outcomes, even though there are substantial clinical benefits proven to occur with thyroid lobectomy with regard to surgical complications.
8. Line 52 and 54 - Please use the word malignancy instead of malignity.
Author Response
Thank you for your very positive comments.
We have modified our article based on your suggestions. The changes are clearly highlighted in the text (in red).
- “Increasing rates of DTC are believed to be related mostly to the common use of POC ultrasound screening, but some studies relate it in part to the rising frequency of thyroid autoimmunity. Please add that to your introduction”.
We have modified the introduction accordingly and added one new reference.
2-4. “In section 2.3 Thyroid nodule molecular testing, please make a note of newer methods under development, arising from recent studies e.g. tumor microenvironment, immune cells etc”. “In section 2.3 Thyroid nodule molecular testing please make a note on the unsatisfactory positive predictive values of commonly used tests and its impact on preoperative diagnosis”. “In section 2.3 Thyroid nodule molecular testing lines 122-125 please note that the cost of diagnostic surgery vs molecular testing for the management of indeterminate nodules is clearly more cost-effective based on the US market values of these procedures”.
We have modified this section accordingly.
- “Despite the recent eighth edition of the Union for International Cancer Control (UICC) tumor, node, metastasis (TNM) classification of malignant tumors (section 2.4) it is established that minimal ETE is associated with statistically significantly higher risk of recurrence, especially in the presence of lymph node involvement, even though not used in staging these tumors”.
We have modified this section accordingly and added one new reference.
- “In the choice of surgical treatment for low risk DTC patients, the meta-analysis of Rodriguez Schaap is mentioned (lines 227-230), but this work is limited by the retrospective observational nature of all the studies meta-analyzed”.
We agree with your comment. We have added a short comment on this limitation of this study in this paragraph.
- “Similarly, the study (reference 33) of the group of JA Sosa is limited by the retrospective nature and the relatively short duration of follow up, given that the main outcome is mortality from low risk thyroid cancer. We feel that a mention should be added about the need for a long term prospective trial comparing the outcomes obtained with each type of operation, with regard to oncological outcomes, even though there are substantial clinical benefits proven to occur with thyroid lobectomy with regard to surgical complications”.
We agree with your comment. We have modified this paragraph accordingly.
- “Line 52 and 54 - Please use the word malignancy instead of malignity”.
We have done the suggested correction.
Reviewer 2 Report
You did a revisions but it seems like chapter of a book . Why dont you performe something more structured?
Author Response
We are sorry for not understanding this comment. This was the first submission and not a revision. The other two reviewers stipulated that our article was very well written and structured.
Reviewer 3 Report
This review article broadly describes recent advances in diagnosis, surgical treatment, and treatment strategy for thyroid cancer. While the article itself does not reveal any new findings, it is a well-organized review article that provides a good overview of the current state of the art in surgery for thyroid cancer.
Author Response
Thank you for your encouraging comments.
We agree that our article does not reveal any new findings since it only aimed to provide a comprehensive overview of the current state of the art in the surgical management of patients with differentiated thyroid cancer. We are glad that the reviewer 3 found this article clear and well organized.
Round 2
Reviewer 2 Report
You did a revision and you did not show the method
