Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia

Awoke Derbie; Bereket Amare; Eyaya Misgan; Endalkachew Nibret; Melanie Maier; Yimtubezinash Woldeamanuel; Tamrat Abebe

doi:10.1371/journal.pone.0274466

Peer Review History

Original SubmissionApril 12, 2022
4 Aug 2022 Decision Letter - Lucinda Shen, Editor PONE-D-22-10841Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest EthiopiaPLOS ONE Dear Dr. Derbie, 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. The manuscript has been evaluated by two reviewers, and their comments are available below. The reviewer has raised a number of concerns related to reporting of the study methodology and results. In particular, the reviewers had requested additional information regarding samples size calculations, participant recruitment as well as the current cervical screening practices in the study location. It may be seen that one of the reviewers had commented on the scientific impact of the study. While PLOS ONE does not issue decisions based on perceived novelty we do however require studies to further contribute to scientific knowledge, https://journals.plos.org/plosone/s/criteria-for-publication#loc-2. As such we suggest discussing related literature and how the current study further contributes to scientific knowledge. Finally, one of the publication criteria at PLOS ONE (https://journals.plos.org/plosone/s/criteria-for-publication#loc-5 )is that articles must be presented in an intelligible fashion and written in clear, correct, and unambiguous English. Both reviewers had raised concerns regarding the quality of English language of the mansucript and we recommend thoroughly copy editing the mansucript for language presentation. Please submit your revised manuscript by Sep 17 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, Lucinda Shen, MSc Staff Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 4.Thank you for stating the following financial disclosure: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” At this time, please address the following queries: a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. [Note: HTML markup is below. Please do not edit.] 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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 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 ****** 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: Yes Reviewer #2: Yes ****** 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: Comments to the authors While it would be of some interest, this study does not bring any breakthrough to the scientific community. Generally, the manuscript has a lot of grammatical errors and inappropriate use of vocabulary. The specific comments include: Background 1. The data reported in P3L66-67 should be cited. 2. Sentences expressing feelings need to be avoided in your writings. For instance, “….. interesting report….” P3L76. 3. The second paragraph is missing the state-of-the-art description of the burden of cervical cancer and associated prevention program in Ethiopia, especially the screening program. In addition, appropriate references related to Ethiopia are missing (P3L74-79). This should be rewritten. 4. P6L145-154 should be summarized and shifted to the background section. 5. The purpose of the study is not clear. I guess the authors wanted to identify the risk factors associated with the burden of cervical cancer in the studied population. The question is what did they achieve with this study? The conclusion being vague is not giving any feasible answer. Materials and Methods 6. The authors need to revise the histopathological classification of cervical cancer cases according to the World Health Organization classification of tumors from women reproductive organs. The subtypes are benign, precancerous, and cancerous cervical lesion. The following reference might be of help in revising your work: - Zuberi, Z., Mremi, A., Chilongola, JO., Semango, G., and Sauli, E. (2021). Expression of p16 and TOP2A biomarkers associated with clinico-histopathological features among women seeking cervical cancer care in Tanzania. PLoS One, 16 (10): e0259096 Results 7. The authors should report the mean age as mean ± SD and not mean, SD in Table 1. 8. The subheadings of demographic characteristics, the histological profile of the participants, and reproductive and gynecological features can be merged into a new subheading titled “Clinical histopathological features among women seeking cervical cancer care.” In addition, the subheading P10L209 should be renamed to “Risk factors associated with cervical lesions among women seeking cervical cancer care.” 9. The incorrect in-text citation of the table at P8L195 should be Table 2, not Table 1. 10. The findings presented at L181-219 should be supported by the biological relevance of the study observations. 11. Why statistical significance was not presented in Table 2? That’s to say, include the p-values. 12. In Table 2, the univariate logistic regression could be performed for benign, precancerous, and cancerous cervical lesions to identify the risk factors associated with cervical cancer lesions. 13. What exclusion and inclusion criteria were deployed to combine high-grade (CIN-2) and cervical cancer lesions? CIN-3 is also a high-grade cervical lesion, why was excluded? 14. Why a p-value ≤ 0.25 was considered for univariate regression analysis (P7L159-160)? 15. Figure 1 should be improved by following the histopathological classification of cervical cancer cases according to the World Health Organization classification of tumors from women reproductive organs by Kurman et al. 2014. Discussion 16. The discussion should be completely rewritten. In addition, the discussion is repeating the results that is unnecessary. Reviewer #2: The paper "Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia" aimed to determine the histopathological profile of 335 women and risk factors associated with high-grade cervical lesions and cancer over a period of 2.5 years in northwest Ethiopia. It is necessary to do this type of work, to publicize the cervical characteristics of the patients as well as unifying criteria between pathologists. The paper is interesting and fairly well written. The data which are presented are moderate to clearly presented though there are several issues that deserve more attention or should be improved. Specific points: Methods section 1. The authors should give some more information on how current screening in Ethiopia or area of study is organized. Are cervical scrapes performed? Is there any way of screening with pap-smears after which women are referred for colposcopy with cervical biopsy? This will give the reader a better understanding why cervical punch biopsies were taken blindly in the current study. 2. This being a prospective study, authors should explain how sample size was determined? The authors should clearly explain how they reached at a sample size of 335. Results section 1. It is good to note that Table 1 has both demographic and clinical characteristics. What does Bahir Dar 2021 on line number 197 and all the tables titles mean? Unless it is in agreement with the journal requirement I recommend that the authors delete it from all the tables, because it does not make sense. In Table 1 o you report 335 participants but the sum of life time number of sexual partners is 332 (163 + 169=332) less than total participants, number of deliveries is 342 (59+86+197=342) exceeding number of participants in the study. o It is also indicated that there were 70 participants who reported to have used hormonal contraceptives but the breakdown for years of hormonal contraceptive use is 57 (32+15+10 =57). o The women who had heard about cervical cancer are 142 but when they were asked how it is transmitted only 124 (10+114=124) responded. Some are missing o The same applies to those screened for cervical cancer in the last 5 years and high-risk Human papillomavirus (HR-HPV) detection Conclusion 1. Even though the majority of the study participants lived in the rural setting (66%), had no formal education (77.3%) and never heard about cervical cancer (57.6%), the conclusion does not specifically address this population. Minor issues 1. Authors should proof read the manuscript because there are a few typos and language that need to be corrected. For example in results section line number 174, in discussion section line number 240, 245, 324 amongst others. 2. Authors also need to check that references, words, symbols and stats are not running into each other. For example words vs references are in background section line number 72, discussion section line number 235 etc ****** 6. 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: Yes: Paul Uchizi Kaseka ******** [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. Attachments Attachment Submitted filename: PLOS ONE REVIEWERS COMMENT.docx https://doi.org/10.1371/journal.pone.0274466.r001
Revision 1
20 Aug 2022 Author Response Comments to the Author Reviewer #1: Comments to the authors While it would be of some interest, this study does not bring any breakthrough to the scientific community. Generally, the manuscript has a lot of grammatical errors and inappropriate use of vocabulary. • Dear reviewer, thank you so much for your important comments and suggestion. We have gone through the entire paper and we made all possible corrections in the revised version of the manuscript. The specific comments include: Background 1. The data reported in P3L66-67 should be cited. • Thank you, a correction has been made. 2. Sentences expressing feelings need to be avoided in your writings. For instance, “….. interesting report….” P3L76. • Thank you, correction has been made. 3. The second paragraph is missing the state-of-the-art description of the burden of cervical cancer and associated prevention program in Ethiopia, especially the screening program. In addition, appropriate references related to Ethiopia are missing (P3L74-79). This should be rewritten. • Thank you, corrections have been made at this point. Kindly check the second paragraph. 4. P6L145-154 should be summarized and shifted to the background section. • Thank you, the summary of this part is shifted to the background section. 5. The purpose of the study is not clear. I guess the authors wanted to identify the risk factors associated with the burden of cervical cancer in the studied population. The question is what did they achieve with this study? The conclusion being vague is not giving any feasible answer. • Dear reviewer, as we have clearly indicated in the last paragraph of the background section, the objective of this study is to determine the histopathological profile of women and risk factors associated with high-grade cervical lesions and cancer (CIN2+C) in northwest Ethiopia. It is not about burden of cervical cancer among the studied population. Materials and Methods 6. The authors need to revise the histopathological classification of cervical cancer cases according to the World Health Organization classification of tumors from women reproductive organs. The subtypes are benign, precancerous, and cancerous cervical lesion. The following reference might be of help in revising your work: - Zuberi, Z., Mremi, A., Chilongola, JO., Semango, G., and Sauli, E. (2021). Expression of p16 and TOP2A biomarkers associated with clinico-histopathological features among women seeking cervical cancer care in Tanzania. PLoS One, 16 (10): e0259096 • Dear reviewer, thank you for the reference. According to the provided citation in Table 1, the authors tried to classify the histopathological features into three main groups (benign, precancerous, and cancerous lesions) and they also further classified these into subgroups, which is in line with our classification scheme. To appreciate the overall histological profile of cervical samples from women, such an explicit approach is much better than presenting the histological report in only three groups. On top of this, there are histological findings that cannot be accommodated in these groups (like the normal histology and the NOS groups). Kindly note that there is no single best approach to classify cervical histological findings into different groups. However, if still the reviewer insists to present our cervical histology data only in three groups, we can do that in the later version of the manuscript. Results 7. The authors should report the mean age as mean ± SD and not mean, SD in Table 1. • Thank you, we have revised this. 8. The subheadings of demographic characteristics, the histological profile of the participants, and reproductive and gynecological features can be merged into a new subheading titled “Clinical histopathological features among women seeking cervical cancer care.” In addition, the subheading P10L209 should be renamed to “Risk factors associated with cervical lesions among women seeking cervical cancer care.” • Thank you, corrections have been made. Kindly check this in the revised version of the result section. 9. The incorrect in-text citation of the table at P8L195 should be Table 2, not Table 1. • Dear reviewer, kindly check that the citation is correct. The statement that states the prevalence of high-risk HPV (HR-HPV) at 54.3% (178/335) is presented in Table 1 (not in Table 2). 10. The findings presented at L181-219 should be supported by the biological relevance of the study observations. • Dear reviewer, the findings reported in this part (L181-219 ) of the first submission represents the reproductive and gynecology related features and important risk factors that predict high-grade cervical lesions and cancer. The variables stated in this section were adopted from previous similar works and they are biologically relevant with our outcome variables. 11. Why statistical significance was not presented in Table 2? That’s to say, include the p-values. • Dear reviewer, in Table 2 we have indicated the crude bivariable logistic regression analysis where we learn about statstical significance indirectly from the provided confidence interval. However, we have presented the p–value in in our multi-variable logistic regressio analysis part (Table 3) apart from the confidence interval. 12. In Table 2, the univariate logistic regression could be performed for benign, precancerous, and cancerous cervical lesions to identify the risk factors associated with cervical cancer lesions. • Dear reviewer, one of the objective of our study is to find out factors associated with high-grade cervical lesions and cancer. We did multivariable analysis for CIN2, CIN3 and cancer (the so-called CIN2+C lesions). However, due to their limited clinical significance we were not interested to run multivariable logistic regression for benign lesions. 13. What exclusion and inclusion criteria were deployed to combine high-grade (CIN-2) and cervical cancer lesions? CIN-3 is also a high-grade cervical lesion, why was excluded? • Dear reviewer, thank you for the question. Kindly note that CIN2+C referes to CIN2, CIN3 and cervical cancer cases together. Hence, the analysis in Table 3 didn‘t exclude CIN3, rather it is part of the analysis. 14. Why a p-value ≤ 0.25 was considered for univariate regression analysis (P7L159-160)? • Dear reviewer, according to the reference we have cited at this point of the first manuscript submission, P7L160, (Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17-. doi: 10.1186/1751-0473-3-17. ), p-value of 0.2-0.25 can be considered to select variables for multivariable logistic regression test based on the clinical or statistical significance. Hence, we took 0.25 to select variables in bivariable analysis for the multivariable logistic regression considering their biological/clinical significance. 15. Figure 1 should be improved by following the histopathological classification of cervical cancer cases according to the World Health Organization classification of tumors from women reproductive organs by Kurman et al. 2014. • Dear reviewer, our explanation for your question on Figure 1 is same as we presented for Q #6. Kindly check this above. Discussion 16. The discussion should be completely rewritten. In addition, the discussion is repeating the results that is unnecessary. • Thank you, it would have been fine if you had indicated the specific areas of this section that needs rewritten. However, after reading the section between a line we made all necessary amendments to make it more readable. Reviewer #2: The paper "Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia" aimed to determine the histopathological profile of 335 women and risk factors associated with high-grade cervical lesions and cancer over a period of 2.5 years in northwest Ethiopia. It is necessary to do this type of work, to publicize the cervical characteristics of the patients as well as unifying criteria between pathologists. The paper is interesting and fairly well written. The data which are presented are moderate to clearly presented though there are several issues that deserve more attention or should be improved. • Thank you, your positive feedback about the paper is highly appreciated! Specific points: Methods section 1. The authors should give some more information on how current screening in Ethiopia or area of study is organized. Are cervical scrapes performed? Is there any way of screening with pap-smears after which women are referred for colposcopy with cervical biopsy? This will give the reader a better understanding why cervical punch biopsies were taken blindly in the current study. • Dear reviewer, thank you for your comments and questions. Due to a number of reasons (especially, because of the absence of basic infrastructure for histo-pathological examination, including pathologists) currently cervical cancer screening in Ethiopian is performed using the VIA technique in almost all public hospitals and facilities. We have indicated this in the background and discussion section of the revised manuscript. • However, there are private settings that provide pap-smear and HPV-based tests. In our study, we recruited women for punch biopsy examination just to see the distribution of histological profiles among women presented with different cervical abnormalities and in connection to find out important risk factors that could predict high-grade cervical lesions and cancer to help guide public health intervention measures. 2. This being a prospective study, authors should explain how sample size was determined? The authors should clearly explain how they reached at a sample size of 335. • Dear reviewer, the sample size was estimated by using the proportion of high-grade cervical lesion at 27% among women attending the outpatient clinic of the department of Gynecology, Tikur-Anbessa Hospital (Ethiopia), at 5% margin of error and 95% confidence level. We have added 10% non-response rate. We have consulted this citation to take the proportion (Wolday, D., et al., HPV genotype distribution among women with normal and abnormal cervical cytology presenting in a tertiary gynecology referral Clinic in Ethiopia. Infect Agent Cancer, 2018. 13(28): p. 018-0201). A revision has been made in the manuscript. Kindly check this. Results section 1. It is good to note that Table 1 has both demographic and clinical characteristics. What does Bahir Dar 2021 on line number 197 and all the tables titles mean? Unless it is in agreement with the journal requirement I recommend that the authors delete it from all the tables, because it does not make sense. • Thank you, we deleted that. We put Bahir Dar and 2021 in each table to make the table self-explanatory in which the ‘what’, ‘where’ and ‘when’ can easily read from the tables. In Table 1 o you report 335 participants but the sum of life time number of sexual partners is 332 (163 + 169=332) less than total participants, number of deliveries is 342 (59+86+197=342) exceeding number of participants in the study. o It is also indicated that there were 70 participants who reported to have used hormonal contraceptives but the breakdown for years of hormonal contraceptive use is 57 (32+15+10 =57). o The women who had heard about cervical cancer are 142 but when they were asked how it is transmitted only 124 (10+114=124) responded. Some are missing o The same applies to those screened for cervical cancer in the last 5 years and high-risk Human papillomavirus (HR-HPV) detection • Dear reviewer, thank you so much for the insightful comment. For some of the variables, the discrepancy in figures happened because of missing data while the questioner based items were collected by nurses. • There was typing error while transcribing the number of deliveries into the table. Now, it is revised in Table 1. Conclusion 1. Even though the majority of the study participants lived in the rural setting (66%), had no formal education (77.3%) and never heard about cervical cancer (57.6%), the conclusion does not specifically address this population. • Dear reviewer, thank you. We have revised this section based on your important suggestion. Kindly check this in the conclusion part of the revised document. Minor issues 1. Authors should proof read the manuscript because there are a few typos and language that need to be corrected. For example in results section line number 174, in discussion section line number 240, 245, 324 amongst others. • Thank you, we made all the necessary corrections to make the revised paper readable at these lines and others. 2. Authors also need to check that references, words, symbols and stats are not running into each other. For example words vs references are in background section line number 72, discussion section line number 235 etc • Thank you, we have checked that. With kind regards! Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0274466.r002
30 Aug 2022 Decision Letter - Paul Uchizi Kaseka;, Editor Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia PONE-D-22-10841R1 Dear Dr. Awoke Derbie 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. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Paul Uchizi Kaseka;, MSN Guest Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0274466.r003
Formally Accepted
2 Sep 2022 Acceptance Letter - Paul Uchizi Kaseka;, Editor PONE-D-22-10841R1 Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia Dear Dr. Derbie: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Paul Uchizi Kaseka; Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0274466.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .