A scoping review protocol on diagnostic strategies to detect occult malignancies in individuals with ischemic stroke

Jenneke Leentjens; Nicholas L. J. Chornenki; Janneke Spiegelenberg; Valentina Ly; Dariush Dowlatshahi; Deborah M. Siegal

doi:10.1371/journal.pone.0289048

Peer Review History

Original SubmissionSeptember 28, 2022
21 Dec 2022 Decision Letter - Fateen Ata, Editor PONE-D-22-25756A scoping review protocol on diagnostic strategies to detect occult malignancies in individuals with ischemic strokePLOS ONE Dear Dr. Leentjens, 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 Feb 04 2023 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, Fateen Ata, MD 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. Additional Editor Comments: While it is an interesting review topic, the reviewers have suggested some integral revisions to be made, after which the protocol can be reviewed again. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Partly Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 Reviewer #3: No Reviewer #4: 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 Reviewer #3: Yes Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. It is unclear why the authors chose to pursue a scoping review instead of a systematic review for this topic. At least some explanation is necessary. 2. There is a very recent review published on the same topic in 2022 (see: pubmed.ncbi.nlm.nih.gov/36192850). This should be referenced and the rationale for the present review better justified. Reviewer #2: Dear editor, I reviewed the article received by Leentjens et all on scoping review on cancer as possible etiology of infarctive stroke. The protocol is well written and the strategies part in the tables in elucidated well. I have just one question for the authors 1. Have figured out any statistical analysis plans for the data? If yes what kind of data would the team extract and how are they planning on analysing it? 2. While its clearly a scoping review, I am interested to know how have the authors planned on presenting the findings from expert opinions, narratives and guidelines which they listed as part of inclusion criteria. Will they present descriptively side by side with data analysis? If there is a plan to run statistical analysis, the authors need to elaborate on that clearly. Otherwisethere is any need to update the manuscript. I wish the authors best of luck with their submission and the review Reviewer #3: This manuscript sheds light on the long neglected topic of occult cancer in ischaemic stroke patients. The knowledge gap regarding the screening strategy end efforts to diagnose, or even more important exclude the possibility of underlying cancer, is clinically highly relevant. I am looking forward to see the results of your work. I have some minor comments to the abstract: I did not found proper reference for the facts you present in the Background ''Up to 10% of individuals with cryptogenic ischemic stroke are diagnosed with cancer within one year, which is similar to the incidence of occult cancer in individuals with unprovoked (no identifiable risk factors) thromboembolism (VTE) (10, 11). '' Ref 10 and 11 regard VTE patients and not ischaemic stroke, most of them due to arterial source. My other comment is about the methodology, could you please elaborate the method part, regarding type of the review you chose. Reviewer #4: Thank you for the invitation to review the manuscript which is research about the occult malignancies in patients with ischemic stroke. In my opinion this scientific protocol is laborious and helpful work in this area. I hope that studies in the subject will continue. Some of the literature is older than 5 years but there are articles from 2021/22 in the manuscript so the authors also base on new researches. Minor comments The reference (#7) is a report of meta-analysis, so if the authors would like to cite it as is, they should change the description in the text from “several studies” to "meta-analysis". If the authors would like to keep the description, the reviewer recommend citing the study by Navi et al (PMID: 28818202) and Mulder et al (PMID: 34396325). ******* 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 Reviewer #3: Yes: Barbara Ratajczak-Tretel Reviewer #4: No ******** [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: peerrevew_PLOS.docx https://doi.org/10.1371/journal.pone.0289048.r001
Revision 1
2 Mar 2023 Author Response Dear editor, I reviewed the article received by Leentjens et all on scoping review on cancer as possible etiology of infarctive stroke. The protocol is well written and the strategies part in the tables in elucidated well. I have just one question for the authors 1. Have figured out any statistical analysis plans for the data? If yes what kind of data would the team extract and how are they planning on analysing it? R: The objective of our review is to summarize the evidence from available studies . We will use descriptive statistics to summarize our findings including mean with standard deviation, or median with interquartile range for continuous variables, and proportions for categorical variables, where appropriate. We will calculate the positive/negative predictive value of a diagnostic test, when available but will not perform comparative analyses between studies, nor will we pool the results in meta-analysis. 2. While it is clearly a scoping review, I am interested to know how have the authors planned on presenting the findings from expert opinions, narratives and guidelines which they listed as part of inclusion criteria. Will they present descriptively side by side with data analysis? R: We will summarize the recommendations from narrative reviews and guidelines in separately from other studies. The type of article (narrative review/guideline) will be stated in the “study design” section and their recommendations in the “key-findings” section. For narrative reviews/guidelines all other items in the chart will be scored as “not applicable”. 3. If there is a plan to run statistical analysis, the authors need to elaborate on that clearly. Otherwise there is no need to update the manuscript. R: we do not plan to run perform comparative analysis nor will we pool the results in meta-analysis. Attachments Attachment Submitted filename: Response to reviewer_scoping review protocol def.docx https://doi.org/10.1371/journal.pone.0289048.r002
22 Mar 2023 Decision Letter - Fateen Ata, Editor PONE-D-22-25756R1A scoping review protocol on diagnostic strategies to detect occult malignancies in individuals with ischemic strokePLOS ONE Dear Dr. Leentjens, 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. ============================== ACADEMIC EDITOR:Dear Authors, In the revised manuscript you have commented on only 1 reviewer's comments, to proceed further you need to address the comments raised by all reviewers. ============================== Please submit your revised manuscript by 20/04/2023. 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, Fateen Ata, MD 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. Additional Editor Comments (if provided): Dear Authors, In the revised manuscript you have commented on only 1 reviewer's comments, to proceed further you need to address the comments raised by all reviewers. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Partly Reviewer #4: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #4: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Reviewer #1: Yes Reviewer #4: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 #4: 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 #4: Yes ******** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for the revisions. The manuscript is acceptable. I have no further comments to the authors. Reviewer #4: The reviewer has reviewed the revised manuscript made by the authors. Unfortunately, the authors' responses to the Reviewers' comments are inadequate. ****** 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 #4: No ******** [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. https://doi.org/10.1371/journal.pone.0289048.r003
Revision 2
19 Jun 2023 Author Response Reviewer 1: 1. It is unclear why the authors chose to pursue a scoping review instead of a systematic review for this topic. At least some explanation is necessary. R: Thank you for the opportunity to clarify the rationale for a scoping review on the topic of cancer screening after cryptogenic ischemic stroke.. Action: we added “Given the uncertainty about the extent and type of existing literature regarding screening for occult cancer in patients with ischemic stroke and likely heterogeneity in the type of tests evaluated and settings in which testing is conducted, we will map the available evidence in this scoping review in order to identify current knowledge gaps prior to undertaking a systematic review.” to the introduction paragraph. 2. There is a very recent review published on the same topic in 2022 (see: pubmed.ncbi.nlm.nih.gov/36192850). This should be referenced and the rationale for the present review better justified. R: There is significant interest in understanding the relationship between occult cancer and unexplained thrombosis (both venous and arterial) and whether enhanced detection can improve prognosis. The citation provided addresses screening for occult cancer after unprovoked venous thromboembolism. Although there may be some overlap for these cardiovascular conditions, they are distinct vascular diseases affecting different patient populations with different etiologies and natural histories such that the data cannot be generalized. Reviewer 2: Dear editor, I reviewed the article received by Leentjens et all on scoping review on cancer as possible etiology of infarctive stroke. The protocol is well written and the strategies part in the tables in elucidated well. I have just one question for the authors 1. Have figured out any statistical analysis plans for the data? If yes what kind of data would the team extract and how are they planning on analysing it? R: We will not perform any statistical analysis apart from the calculation of the positive/negative predictive value of a diagnostic test, when available. The design of our scoping review is purely descriptive. We will chart the available studies but do not intend to perform qualitative comparisons between studies. 2. While its clearly a scoping review, I am interested to know how have the authors planned on presenting the findings from expert opinions, narratives and guidelines which they listed as part of inclusion criteria. Will they present descriptively side by side with data analysis? R: We will include the recommendations from narrative reviews and guidelines in the standardized data extraction form, side to side to other relevant studies. The type of article (narrative review/guideline) will be stated in the “study design” section and their recommendations in the “key-findings” section. For narrative reviews/guidelines all other items in the chart will be scored as “not applicable”. Reviewer 3: This manuscript sheds light on the long neglected topic of occult cancer in ischaemic stroke patients. The knowledge gap regarding the screening strategy end efforts to diagnose, or even more important exclude the possibility of underlying cancer, is clinically highly relevant. I am looking forward to see the results of your work. 1. I have some minor comments to the abstract: I did not found proper reference for the facts you present in the Background *''Up to 10% of individuals with cryptogenic ischemic stroke are diagnosed with cancer within one year, which is similar to the incidence of occult cancer in individuals with unprovoked (no identifiable risk factors) thromboembolism (VTE) (10, 11). '' Ref 10 and 11 regard VTE patients and not ischaemic stroke, most of them due to arterial source. R: we added PMID 31231302 as relevant reference regarding ischemic stroke. 2. My other comment is about the methodology, could you please elaborate the method part, regarding type of the review you chose. R: Thank you for the opportunity to clarify the rationale for scoping review. Action: we added “Given the uncertainty about the extent and type of existing literature regarding screening for occult cancer in patients with ischemic stroke stroke and likely heterogeneity in the type of tests evaluated and settings in which testing is conducted, we will map the available evidence in this scoping review in order to identify current knowledge gaps prior to undertaking a systematic review.” to the introduction paragraph. Reviewer 4: Thank you for the invitation to review the manuscript which is research about the occult malignancies in patients with ischemic stroke. In my opinion this scientific protocol is laborious and helpful work in this area. I hope that studies in the subject will continue. Some of the literature is older than 5 years but there are articles from 2021/22 in the manuscript so the authors also base on new researches. Minor comments The reference (#7) is a report of meta-analysis, so if the authors would like to cite it as is, they should change the description in the text from “several studies” to "meta-analysis". If the authors would like to keep the description, the reviewer recommend citing the study by Navi et al (PMID: 28818202) and R: we thank the reviewer for this suggestion and changed the manuscript accordingly (and added PMID: 34396325, and 28818202 instead of the meta-analysis). https://doi.org/10.1371/journal.pone.0289048.r004
11 Jul 2023 Decision Letter - Fateen Ata, Editor A scoping review protocol on diagnostic strategies to detect occult malignancies in individuals with ischemic stroke PONE-D-22-25756R2 Dear Dr. Leentjens, 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, Fateen Ata, MD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #4: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #4: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Reviewer #4: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 #4: 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 #4: Yes ******** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: The authors have addressed the reviewers' comments adequately. I have no additional comments to provide. ****** 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 #4: No ******** https://doi.org/10.1371/journal.pone.0289048.r005
Formally Accepted
14 Jul 2023 Acceptance Letter - Fateen Ata, Editor PONE-D-22-25756R2 A scoping review protocol on diagnostic strategies to detect occult malignancies in individuals with ischemic stroke. Dear Dr. Leentjens: 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. Fateen Ata Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289048.r006

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