Ovarian Masses-Applicable IOTA ADNEX Model versus Morphological Findings for Accurate Diagnosis and Treatment

Round 1

Reviewer 1 Report

I carefully reviewed the manuscript entitled “Ovarian masses - applicable IOTA ADNEX model versus morphological findings for accurate diagnosis and treatment” by Butureanu and colleagues. This article aims to explore the use and the efficacy of the IOTA ADNEX model in the diagnosis of ovarian masses. As the authors stated in their manuscript, the diffusion of this method in developing countries could help the management of this conditions with a concomitant reduction of financial costs. This point makes the aim truly interesting, since it adds a socioeconomic aspect to a scientific purpose.

However, the study suffers from some crucial flaws that do not allow to consider it suitable for the publication in its current form. The main one is that the study design is completely lacking, and it is impossible to understand if the study is structured enough to answer to the scientific question. If the aim is to asses if the IOTA ADNEX method is efficient enough, the study design must include a well-conceived statistical plan in which the results are compared with the gold standard method, the histological exam in the present case. In this study, the statistical analysis is not presented (and present) at all, there are just some percentages.

In the present version, it is not possible to understand if these absences are due only to an omission during the writing process or during the study conception. In the first case, the authors should accurately rewrite the manuscript in order to include a clear and well developed study design with the statistical part, while, in the second case, the article could not present the skills to be suitable for publication.

Here below some suggestions to address the previous points:

• The aim was to compare the IOTA ADNEX model to the histology, which is the gold standard. At the same time, the authors declared that they want to evaluate if the IOTA ADNEX model is more precise than the normal ultrasound exam. To resume, the study wants to compare ultrasound efficiency vs IOTA ADNEX efficiency, and this latter to histology. In all the text, there are no mentions about how these comparison were carried out. Which statistical tests have been used? Which kind of coefficients have been calculated to asses if one method is better of another one, or if they are similar?
• Which classification did the authors use to identify the ultrasound diagnosed alterations? And which histological classification? Why?
• The statistical approach must be added, since it is not present in Materials and methods’ section. Which tests did the authors chose and why? In the current form, there are just percentages that are quickly interpreted in the discussion.
• In the manuscript, the authors often use the words “correlation” or “correlate”. In statistics, the word “correlation” is used to define a precise measure, obtained using specific tests and calculating coefficients of correlation. Here, it is used, in my opinion, in a unproper way, since the authors just compare percentages without using any of these tests.

Finally, English should be deeply amended, since several flaws are present throughout the text.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The study presented in this article evaluated the correspondence between the IOTA ADNEX model and the histopathological diagnosis. The study is well conducted and presented. The authors clearly explained the results in the discussion section, underlining also the limitations of the study.

Though, I would suggest some improvements to authors, in order to increase the quality of the article for the publication:

1) Include statistical analysis, specifying the approach and tests in materials and methods.

2) Improve the quality of histological images.

3) Specify the classification used for histological diagnosis of ovarian tumors (e.g. WHO 2020?)

4) Describe better in discussion section the possible reasons of false negative cases and what can be done to improve the IOTA ADNEX model.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Dearest Authors, I read with interest this paper that I believe it is well written and interesting. I have no major comment to make, but only two minor comments that I write below.

Minor comments:

Line 64: ovarian mases, please correct!

Histological image: improve the quality and delete yellow color that is very unsightly.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

I thank the authors for their effort in answering to my concerns.

I think that the manuscript is now suitable for the publication in the journal.