Serous Borderline Ovarian Tumor Diagnosis, Management and Fertility Preservation in Young Women
Round 1
Reviewer 1 Report
Each case should be described separately and more precisely.
It is worth considering the role of ultrasound in the diagnosis of these tumors.
The discussion is rather a review of selected problems in the diagnosis and treatment of BOT. Recent recommendations of ESMO-ESGO have not been taken into account.
Author Response
Revisions notes:
Each case should be described separately and more precisely.
Answer: we rewrited completely the results section to describe the 3 cases separately and more precisely.
It is worth considering the role of ultrasound in the diagnosis of these tumors.
We added in the discussion “Ultrasound has a lower sensitivity and specificity than RMI which is the gold standard to evaluate ovarian masses, nevertheless the low false positive rate of ultrasound show that it is a good first line imaging(17)”
The discussion is rather a review of selected problems in the diagnosis and treatment of BOT. Recent recommendations of ESMO-ESGO have not been taken into account.
We included in discussion the recent recommendations of ESMO-ESGO:
“Destructive stromal invasion is no longer necessary for carcinoma diagnosis according to the European Society for Medical Oncology (ESMO) and European Society of Gynaecological oncology (ESGO) (17)”.
“ Fertility-sparing surgery can be safely offered to all stages IA and IC1 low-grade carcinoma according to the ESMO-ESGO recommendations. This management is safe in patients with conventional low grade stage IA. It is acceptable for stage IC1 tumors, with half of the recurrences being isolated on the remaining ovary and they can be rescued by subsequent surgery (17)”
We modified the sentence “An appendectomy is not recommended any more, even in case of a confirmed mucinous BOT” as appendicectomy is recommended in French guidelines but not in recent ESMO-ESGO ones (17)”.
Author Response File: Author Response.docx
Reviewer 2 Report
interesting report about 3 cases with overview of current decision making and tailored treatment plans.
I suggest reviewing this article by a linguist before a second submitting
70
However
88
On magnetic .... (MRI) , cases 1 and 3 had bilateral ovarian cysts. The cysts on the left side were suspicious: in case 1, aspect of endometriotic cyst with tissue component was identified (figure 1a); in case 2, papillary projection on a liquid unilocular cyst was suspected of malignancy ??? (figure 1b).
97
Case 3
101
in order to avoid a perioperative rupture
102
Immediate-section
103
perioperative rupture .. and a biopsy
104
... a bilateral borderline lesions
107
analysis not studies
107
in all three cases the diagnosis was FIGO I serous BOT
109
in all three cases restaging surgery was
136
in her case
139
have not planned ???? not clear ????
141
at each step, medical record was discussed at multidisciplinary board
table
line presentation case 3 : asymptomatic ?
line surgical approach: laparoscopy with subsequent laparotomy
148
in all three cases
151
have reported
161
invasiveness of the disease
carcinomatous component ?
168
for differentiation between
195
37%
200
The latest French guidelines recommend …
207
And pathologic ovarian surface
209
And experienced a contralateral ovarian relapse managed by a cystectomy
213
On histologic examination
218
On histology
223
That would impact the risk of recurrence
227
Do the authors think that multidisciplinary team should also include gynecologic surgeon specialized oncologic surgery ? experienced radiologist ? what do authors think about systematic review of MRI imaging
232
With its limits and risks
241
Fertility counseling should be preceded by a preoperative
262
Transplanting … involves a risk of …
263
The main limitation of this procedure is the impossibility …
288
Conservative Fertility sparing surgery …
Author Response
Reviewer 2 : Answer
interesting report about 3 cases with overview of current decision making and tailored treatment plans.
I suggest reviewing this article by a linguist before a second submitting
We thank the reviewer for its comments. We made all the asked modifications and An English writer made grammar and language editing before resubmission. You can find here all the modifications performed. As asked by the reviewer 1 we described the 3 cases separately
70
However > modification done
88
On magnetic .... (MRI) , cases 1 and 3 had bilateral ovarian cysts. The cysts on the left side were suspicious: in case 1, aspect of endometriotic cyst with tissue component was identified (figure 1a); in case 2, papillary projection on a liquid unilocular cyst was suspected of malignancy ??? (figure 1b). > for case 1 :” On magnetic resonance imaging (MRI), she was found to have a 65 mm left ovarian cyst with endometriotic aspect and tissue component (figure 1a), diffuse endometriosis, and two endometriomas of 10 and 20 mm on the right ovary.”, case 2: She was found to have on pelvic ultrasound and on MRI (figure 1b) a left unilocular liquid ovarian cyst of 10.2x10x4 cm with solid papillary projections.case 3 : “MRI showed a solid cyst with fat component measuring 40x30 mm on the right ovary, and a left ovarian cyst occupying the whole ovary, measuring 30x10 mm with a peripheral tissue component. The right ovarian cyst’s characteristics were that of a typical dermoid cyst, however the left ovarian cyst’s radiologic characteristics raised suspicion for a possible BOT”
97
Case 3> done
101
in order to avoid a perioperative rupture >done
102
Immediate-section>done
103
perioperative rupture .. and a biopsy >done
104
... a bilateral borderline lesions >done
107
analysis not studies >done
107
in all three cases the diagnosis was FIGO I serous BOT> done
109
in all three cases restaging surgery was >done
136
in her case >done
139
have not planned ???? not clear ???? > we modified the sentence:” The patient didn’t want to perform any fertility preservation to this day”
141
at each step, medical record was discussed at multidisciplinary board > we added this sentence in each case description
table
line presentation case 3 : asymptomatic ? > we added it
line surgical approach: laparoscopy with subsequent laparotomy >done
148
in all three cases>done
151
have reported >done
161
invasiveness of the disease
carcinomatous component ? > we replaced it with malignancy
168
for differentiation between >done
195
37%>done
200
The latest French guidelines recommend …>done
207
And pathologic ovarian surface>done
209
And experienced a contralateral ovarian relapse managed by a cystectomy >done
213
On histologic examination >done
218
On histology >done
223
That would impact the risk of recurrence>done
227
Do the authors think that multidisciplinary team should also include gynecologic surgeon specialized oncologic surgery ? experienced radiologist ? what do authors think about systematic review of MRI imaging : >we added “The multi-disciplinary team must include a gynecologic surgeon specialized in oncologic surgery, an oncologist, an experienced radiologist and an expert in reproductive medicine, and should provide…” and “Systematic review of MRI imaging is useful to precise before surgery the degree of possible invasion of one or two ovaries in order to decide with the patient the best option and avoid re-operations”.
232
With its limits and risks >done
241
Fertility counseling should be preceded by a preoperative>done
262
Transplanting … involves a risk of …>done
263
The main limitation of this procedure is the impossibility …>done
288
Conservative Fertility sparing surgery …>done