Suspected Lung Cancer with Suspicious Liver Lesions: Diagnostic Yield and Safety of Same-Day Bronchoscopy and Liver Biopsy in the Hands of a Pulmonologist

Round 1

Reviewer 1 Report

The authors reported the validity and safety of performing bronchoscopy and liver biopsy on the same day in patients with suspected lung cancer and liver metastases.

However, the conclusion stated in the abstract (reducing the number of days to final diagnosis) is not concluded from the results of this study. The results need to be added so that they can be shown with the data of this study.

In particular, there is a large difference in patient background between the group that underwent bronchoscopy on the same day and the group that did not undergo bronchoscopy, and it is suggested that the comparison should be limited to lung cancer patients only. For example, in recent years, the search for genetic mutations using next-generation sequencers has been widely used in the selection of treatment for lung cancer. If it is useful to perform bronchoscopy and liver biopsy on the same day for tissue collection for this purpose, it would be a new finding for the readers.

The authors  also concluded that performing both bronchoscopy and liver biopsy on the same day may reduce the number of patient visits to the hospital. But it is not difficult for a radiologist (or gastroenterologist) and bronchoscopist to work together to perform both liver biopsy and bronchoscopy on the same day.

In Table 3, the correct diagnosis rate of liver biopsy is very high (95%) in the group where bronchoscopy is not performed, and considering the physical burden of bronchoscopy on the patient, there seems to be little merit in performing bronchoscopy on the same day.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

To the authors:

This is a great study however I have some comments and questions:

1. Please specify if there exist a specific training protocol for the pulmonologist to perform Liver biopsies and is this done by ALL or few pulmonologists?

2. How many pulmonologist in total were involved in these biopsies?

3. Were the Liver biopsies repeated? In other words, did any of these patients have biopsies in the past that were failed and if so, who performed those?

4. Please list selection bias in your limitations because it seems these patients were selected. 

5. What was the reason to not compare rates of diagnoses between Radiologist and Pulmonologist performed liver biopsies?

 

Thank you

 

 

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Generally, in my country liver biopsy is not routinely performed by pulmonologists. Therefore, the topic of the paper is interesting and novel. However, according to me this paper does not fit to Advances in Respiratory Medicine journal, but to the journal of hepatology. In this paper only 28 pts had bronchoscopy and in this small group only 16 pts had lung cancer. It is definitely too small study group for the publication.  

 

 

Some English language mistakes:

- line 75: “…percutaneous biopsies from liver…”.

- line 76: ”…patients needing…”

 

In Table 1 you write: no endoscopy group of 61 pts including single liver lesion – 12 and multiple liver lesion – 50. So it is 62 in total, not 61. Please, explain with details in the manuscript.

In line 122 you wrote: “Most patients (n=83; 92%) had a final diagnosis of malignancy…” and in Table 1 you presented: malignancy in liver - 21 in group with bronchoscopy and 58 in group without bronchoscopy, so it is 79 in total (not 83). Please, explain with details in the manuscript.

 

 

The sentence in “Discussion” chapter (lines 161-163) should be rather written in “study limitations” chapter.

 

 

In “References” chapter:

-        Paper 8 – it should be “e16-27’

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The manuscript was appropriately revised for comments.

Reviewer 3 Report

I congratulate with the paper.