Imaging of Gastric Carcinomatosis

Round 1

Reviewer 1 Report

In the article, authors review the imaging modalities used for gastric cancer detection and provide an overview of their imaging appearances, and they also discuss the assessment of response and follow-up recommendation after complete surgical resection. Here are some suggestions. 1. A better abstract is deserved, instead of copying the introduction section. 2. Another section for discussion or conclusion from the authors may better express the authors' own point of view. 3. Perhaps line 382 should be Section 5, and the following paragraphs should be 5.1, 5.2 and 5.3.

Author Response

My co-authors and I would like to thank the Editor and the Reviewers for their thoughtful and insightful comments. We have address these concerns and have made few corrections, and as a result, we believe that the manuscript has been improved.  

 

Point1. A better abstract is deserved, instead of copying the introduction section.

Response 1. Thank you for this comment, the abstract has been corrected accordingly:

“Diagnosing the absence or presence of peritoneal carcinomatosis in patients with gastric cancer, including its extent and distribution, is an essential step in their therapeutic management. It still remains a radiological challenge. In this article, we review the strengths and weaknesses of the different imaging techniques for the diagnosis of peritoneal carcinomatosis of gastric origin as well as its imaging features. We also discuss the assessment of response to treatment and the recommendations in the follow-up of patients with complete surgical resection according to the presence of risk factors of recurrence as well as future directions for imaging improvement. ”

 

Point 2. Another section for discussion or conclusion from the authors may better express the authors' own point of view.

Response 2. A conclusion was indeed missing, thank you for point it out. A conclusion was added to the manuscript as follows:

“The radiological diagnosis of peritoneal carcinomatosis of gastric origin is a challenge. It is essential to have a good clinical orientation and a personalized management of each patient. As none of the existing imaging tools is ideal, the imaging has to be adapted depending on patient condition, tumor pathology and therapeutic situation. A combination of techniques such as thoraco-abdomino-pelvic CT with abdomino-pelvic MRI for pre-operative assessment can be an helpful option. Imaging feature of peritoneal carcinomatosis from GC can be subtle, so a systematic analysis of the peritoneal cavity is mandatory. This requires a good knowledge of the mechanisms of peritoneal dissemination, and a consideration for the anatomical location of the primary tumor that can help in predicting the pattern of peritoneal dissemination. Systematic reading, attention to detail and experience are all essential for an optimal interpretation. The assessment of treatment response is also complicated due to post treatment changes. Identification of risk factors for peritoneal recurrence after complete surgical resection is important in order to make decisions on the therapeutic approach for the patient. There is no universal consensus on how to carry out radiological follow-up, nor on its timing. Regarding new diagnostic techniques, there are promising results in studies with PET-MRI and novel molecules for GC targeting including FAPI PET/CT and FLT PET/CT that appear to be interesting for treatment response monitoring and evaluation of diffuse type of GC, respectively. Moreover, radiomics and deep learning are under investigation for the prediction occult peritoneal metastases in GC. An experienced and dedicated radiologist, as well as a close collaboration between the radiologist, pathologist, oncologist and oncologic surgeon, are essential elements in this multidisciplinary challenge.”

 

Point 3. Perhaps line 382 should be Section 5, and the following paragraphs should be 5.1, 5.2 and 5.3.

Response 3. Thank you for reporting this mistake, the numeration has been adapted.

Reviewer 2 Report

The authors reviewed imaging of gastric carcinomatosis.

I think this article is well-written, and readers of "Journal of Clinical medicine" are going to be interested in this article. 

I would like to point out the part of "Radiomics and deep learning". I think this part is rough. This chapter should be written in more detail.

 

Author Response

My co-authors and I would like to thank the Editor and the Reviewers for their thoughtful and insightful comments. We have address these concerns and have made few corrections, and as a result, we believe that the manuscript has been improved.  

Point 1. I would like to point out the part of "Radiomics and deep learning". I think this part is rough. This chapter should be written in more detail.

Response 1. We agree that this chapter is short and not developed but it was on purpose. Indeed, the present article aim to describe the imaging of peritoneal carcinomatosis in gastric cancer. Radiomics and deep learning are not currently used in the clinical practice but presented here as current research areas in the topic. For that reason, we choose to not give more details on radiomics and deep learning.