The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens

Round 1

Reviewer 1 Report

I read with great interest the authors work. I think they did a very good job. It is a wonderful and detailed summary of diagnostic urine cytology specimens. I have no further comments.

Author Response

Thank you.

Reviewer 2 Report

I read the work presented by Allison and colleagues with interest. The manuscript discusses the literature published on a specific topic, such as the analysis of urothelial tissue fragments before and after implementing the Paris system for reporting urinary cytology.

The review accurately reports the previous literature which is clearly presented. However, the discussion lacks clinical evaluations and the application of these findings in the clinical management of the disease.

 

In my opinion, the paragraphs should be numbered for better clarity.

 

In the paragraph “Urothelial Tissue Fragments in Cell Block Preparations” the authors might add a brief explanation of cell block preparations and what that consists of.

Table 1 has been placed twice in the manuscript (in the middle of the text and at the end), the version at the end of the text (page 19) has better formatting and I would keep that one. In addition, a header should be added to the table explaining the contents, as is usually done.

Author Response

Thank you.

1. We have added a small discussion in two sections more focused on clinical relevance and included references.
2. We have numbered the manuscript headers.
3. We have added an introductory description of cell blocks.
4. We do not know why there was a duplicate Table 1 in the middle of the manuscript. It does not appear in our submitted document or in the document available for us to modify for revision. It is possible it was generated and re-formatted by the journal as part of the review process. However, we will add a header text description of the table and check the final proofs carefully.

Reviewer 3 Report

The authors present a very nicely written comprehensive review on urothelial tissue fragments in cytological urinary specimens. It is important topic with practical implications as urinary cytology is 2nd largest cytology specimen by volume.

I have very few comments/suggestions to improve the text:

Cytology figure panel should be larger as they are crucial in this kind of paper.

One paragraph, how Paris 1st and 2nd edition diffrently face LGUN.

Is there any difference in different preparations, i.e. cytospin vs. liquid base cytologies, Surepath vs. ThinPrep?

Finally, references are not in journal format.

Author Response

Thank you.

1. We have provided very high-resolution images in our submission such that we reached the file size limit to the submission. We are not sure if the images seen by the reviewer were modified or of lower quality than the ones we submitted. However, we will work with the journal during the proof process to ensure the quality and size of the images are maintained through the final publication. 
2. We have added a discussion of how LGUN is handled differently between the 1st and 2nd editions of TPS.
3. While there is no evidence in the literature describing cytomorphologic differences between TP, CS, and SP preparations, this is in part due to lack of studies in the literature. Generally, it is true that SP preparations maintain more of the larger, 3D fragments than TP preparations do. This comment has been added to the manuscript.
4. In the instructions to authors, it is noted that the journal uses a free format submission, with the following statement: "Your references may be in any style, provided that you use the consistent formatting throughout." Thus, we did not select a particular format for references, but they are consistently formatted through the manuscript.