Molecular Analysis of Pancreatic Cyst Fluid for the Management of Intraductal Papillary Mucinous Neoplasms
Manish Manrai
Round 1
Reviewer 1 Report
The Authors reviewed the role of cyst fluid molecular analysis and their utility in the diagnosis and risk stratification of branch duct IPMNs. The reiew is interesting, well-written and shows an old problem: the correct diagnosis of malignant IPMNs, avoiding operation for benign disease. Does molecular analysis of cyst fluid solve this problem? I think it is difficult to answer yes. In all experiences, the number of patients who underwent resection is too small to draw definitive conclusions and the indication for operation was based presumably on the well-established clinical or radiological criteria. In asymptomatic patients, whithout worrisome or high-risk features, does molecular analysis justify pancreatic resection? Moreover, not all laboratories are able to perform this analysis, the cost of such procedures is not clear, the follow-up is too short, and the outcome of non operated cysts is unknown. I think these points require more extensive discussion.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The review is pertinent and relevant.
The discussion needs to be enhanced. The following references are suggested to discussed and subsequently added
1. Arner DM, Corning BE, Ahmed AM, et al. Molecular analysis of pancreatic cyst fluid changes clinical management. Endosc Ultrasound. 2018;7(1):29-33. doi:10.4103/eus.eus_22_17
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6. McCarty TR, Paleti S, Rustagi T. Molecular analysis of EUS-acquired pancreatic cyst fluid for KRAS and GNAS mutations for diagnosis of intraductal papillary mucinous neoplasia and mucinous cystic lesions: a systematic review and meta-analysis. Gastrointest Endosc. 2021 May;93(5):1019-1033.e5. doi: 10.1016/j.gie.2020.12.014. Epub 2021 Mar 26. PMID: 33359054.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
The Authors adequately replied to my comments. The paper is suitable for publication
