PONE-D-21-26569

Diagnostic accuracy of S-Detect in distinguishing benign and malignant thyroid nodules: a meta-analysis

PLOS ONE

Dear Dr. Wang,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

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Nguyen Quoc Khanh Le

Academic Editor

PLOS ONE

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- https://medultrason.ro/medultrason/index.php/medultrason/article/view/2460

- https://www.researchsquare.com/article/rs-16146/v1

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors report a meta-analysis to evaluate the diagnostic accuracy of S-Detect in distinguishing benign and malignant thyroid nodules.

Introduction is quite general, and some statements are misleading. For example, "the sample sizes were not enough" (lines 56-57) should be better explained and referenced.

Keywords. The following keywords and MeSH terms were used: ["thyroid cancer" or "thyroid neoplasm" or "thyroid tumor" or "thyroid nodule "] and [“S-Detect” or “smart detect” or “artificial Intelligence” or "computer aid diagnosis” or “machine intelligent”] (lines 60-62). Some keywords seem to be confusing. What is the meaning of "machine intelligent"? It returns only ten results in Pubmed when directly used as a keyword.

Data extraction (lines 75-78). The researchers collected the following data: the first author's surname, publication year, language of publication, study design, sample size, number of lesions, source of the subjects, "gold standard," and diagnostic accuracy.

I think the researchers collected the number of true positives, true negatives, false positives, and false negatives, instead of diagnostic accuracy. Is this correct?

Furthermore, was the S-Detect version used registered? At least 2 different versions exist.

Moreover, how was the index test interpreted? S-DetectTM for Thyroid is a technology providing the features of the selected nodule with information on 6 features. Instead of directly suggesting malignancy or benignity of the nodules, the software may classify them according to three major thyroid imaging and data reporting systems: K-TIRADS, Russ, and ATA guidelines. So, did the authors collect the mode in which S-Detect was used in each study and the threshold used to "diagnose" malignant cases? Please, clarify.

I think these are important issues that should be added to the meta-regression analysis.

Why was the country of origin of the study not used as a potential variable in the meta-regression analysis?

Reference standard and Selection bias. The inclusion of studies with histological confirmation only is a strength (because histology is a good reference standard), but also a limitation (because surgical series are prone to selection bias). The authors should briefly discuss this issue.

Registration. Was this meta-analysis pre-registered in a public database? (e.g., PROSPERO). Please, clarify.

There are some typos and grammar errors that should be corrected.

Reviewer #2: This meta-analysis aimed to identify the diagnostic accuracy of S-Detect 15 in distinguishing benign and malignant thyroid nodules. I have several suggestions.

1. Please provided the search strategy in each database.

2. Please provide the Fagan diagram.

3. The heterogeneity within studies are very high, and please performed the subgroup analysis or meta-regression.

4. The PLR, NLR and DOR should be reported, too.

5 Please evaluate the threshold effect withing study.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-21-26569R1Diagnostic accuracy of S-Detect in distinguishing benign and malignant thyroid nodules: a meta-analysisPLOS ONE

Dear Dr. Wang,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 08 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Nguyen Quoc Khanh Le

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors addressed my previous questions.

However, some minor edits are still needed:

1. Search strategy. I highlighted an issue with the search criteria. While I agree that the specific keyword is not modifying the query results, the point is: are the authors sure that their strategy missed no appropriate paper? I see that the other reviewer also asked for clarification and complete queries.

The new query (“computer aid diagnosis”) is misspelled (computer-aided diagnosis being the correct spelling).

2. The authors did not find the information about registration and version of the used S-Detect software. It should be discussed as a limitation of the meta-analysis.

3. The country where the study was performed should be included as a variable in the meta-regression analysis reported in Table 2, if possible. If not possible, it should at least be discussed as a limitation.

Reviewer #2: The author had addressed all comments. I have not other questions, and this study can be accepted for publicatoin.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Diagnostic accuracy of S-Detect in distinguishing benign and malignant thyroid nodules: a meta-analysis

PONE-D-21-26569R2

Dear Dr. Wang,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Nguyen Quoc Khanh Le

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: