PONE-D-23-44008Clinicopathologic features and outcomes of bilateral lacrimal gland lesionsPLOS ONE

Dear Dr. He,

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: In my opinion and based on the reviewers` comments the manuscript needs revision. There are some points within the manuscript which must be corrected. The lack of clear Inclusion/Exclusion criteria with inclusion of previously treated patients are major drawbacks on the validity and reliability of the results and outcomes. The paper needs extensive English editing. Please find the attached files with reviewers` comments and carefully addressed all the suggestions.

==============================

Please submit your revised manuscript by Apr 05 2024 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.

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We look forward to receiving your revised manuscript.

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Karolina Goździewska-Harłajczuk

Academic Editor

PLOS ONE

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Additional Editor Comments:

In my opinion and based on the reviewers` comments the manuscript needs revision. There are some points within the manuscript which must be corrected. The lack of clear Inclusion/Exclusion criteria with inclusion of previously treated patients are major drawbacks on the validity and reliability of the results and outcomes. The paper needs extensive English editing. Please find the attached files with reviewers` comments and carefully addressed all the suggestions.

[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: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: 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

Reviewer #3: No

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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: Yes

Reviewer #3: Yes

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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: This study duplicates to a certain extent two other studies looking at bilateral lacrimal gland involvement by various diseases (both cited by these authors), but adds to that knowledge base by presenting a series from China.

There are quite a number of things that could be improved to make the paper more presentable and understandable. In general, the English is not good, and the paper needs extensive editing. Services are readily available online, and it is beyond the remit of the reviewers and editors of the journal to make those changes.

Abstract - Results - "followed by dacryoadenitis" should have "non-specific" added before "dacryoadenitis"

- "inflammatory pseudotumor". This is not a diagnosis now supported by most specialists working in this field. Idiopathic orbital inflammation is a better term. How is this different to non-specific dacryoadenitis? What criteria were used to make this diagnosis and how was it separated from non-specific dacryoadenitis?

Results section of the paper:

- Demographics - what does "hormone therapy" mean?. Please specify what this is.

- Clinical presentation - what is "hypostasis"?

- Laboratory investigations - "the patient with MALT ....", and "The patient with elevated ...." Do you mean just one patient each time, or more than one?

- Radiological investigation - what does "long or equal on both T1 and T2" mean? Please clarify.

- Histopathology classification - what is the difference between dacryoadenitis (presumably non-specific) and inflammatory pseudotumor?

- Treatment - most common was surgery combined with corticosteroids. What exactly was entailed with the surgical part of this? Was it just incisional biopsy, or intentional debulking surgery? Incisional biopsy alone cannot be regarded as "treatment", but is rather an investigation.

Discussion -

- page 13 - the list of "mainly case reports" is misleading. There is a much larger literature than "mainly case reports" for diseases such as sarcoidosis, Erdheim-Chester disease, Sjögren's syndrome.

- page 14 - the paragraph starting "in addition, biopsy should be strongly ..." Why do you then suggest biopsy is NOT recommended in the "effectively treated"? Are some patients treated speculatively without a biopsy?

Images - the histopathological images are of too low power and size to interpret, and add very little to the paper. I would delete them.

Tables - Table 2, 3 and 4 (two last columns) suggest that percentages be added in brackets after each raw number. The raw numbers are relatively meaningless without the percentages.

Reviewer #2: The authors stated in the Results section:

"In addition, 36 patients(27.9%) previously performed relevant treatment,including hormone therapy(n=16),excision of orbital mass (n=8) and submandibular gland(n=4) and eyelid mass (n=2)and conjunctival mass (n=1), fixation of lacrimal gland prolapse(n=2), double eyelid operation (n=1), radiotherapy (n=1) and chemotherapy(n=1)(Table 1)."

This is confusing since 16 patients had hormone therapy presumably for TED, however, the final results of the study didn't show TED cases. Also the authors didn't have well defined Inclusion/Exclusion criteria apart from "bilaterality".

The Bilaterality in some of the cases was identified only by Radiology, which was not clarified in the methodology.

The authors included patients with H/O hormone therapy, radiotherapy, and chemotherapy as well as previous excision of orbital mass.

All the above has negative impact on the validity and reliability of the results and outcome.

It might be wise to exclude those patients with previous therapy and to have the analysis repeated for the cases with primary bilateral LG lesions with no prior medical/surgical interference related to the original pathologies.

The manuscript can be considered after that.

Reviewer #3: 1. Check reference no. 1. The format is not consistent with journal format.

2. Tables 1-5 were not included in the manuscript. Only the figures are available.

I can't relate to the discussion and conclusion.

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Reviewer #1: No

Reviewer #2: Yes: Hind M Alkatan

Reviewer #3: Yes: Shatriah Ismail

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PONE-D-23-44008R1Clinicopathologic features and outcomes of bilateral lacrimal gland lesionsPLOS ONE

Dear Dr. He,

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:

The manuscript was partly improved, however based on Reviewers` suggestions there are still some points which need a general revision.

==============================

Please submit your revised manuscript by Jul 01 2024 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,

Karolina Goździewska-Harłajczuk

Academic Editor

PLOS ONE

Additional Editor Comments:

The manuscript was partly improved, however based on Reviewers` suggestions there are still some points which need a general revision.

[Note: HTML markup is below. Please do not edit.]

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 #2: All comments have been addressed

Reviewer #4: (No Response)

Reviewer #5: (No Response)

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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 #2: Yes

Reviewer #4: Partly

Reviewer #5: Partly

**********

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

Reviewer #2: Yes

Reviewer #4: I Don't Know

Reviewer #5: N/A

**********

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 #2: Yes

Reviewer #4: Yes

Reviewer #5: 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 #2: Yes

Reviewer #4: No

Reviewer #5: No

**********

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 #2: (No Response)

Reviewer #4: This is just the review of a hospital with 129 patients only.

There is no new information in this article

Reviewer #5: Although, according to the authors, no previous study has been published on the clinicopathological characteristics of bilateral lacrimal gland lesions biopsied in Asian populations, this paper has certain shortcomings that are markedly important. The quality of written English language text is at times suboptimal. The authors should specify some details about the referral West China Hospital of Sichuan University and the characteristics of the population it serves.

Furthermore, to enrich the content of the discussion, the authors could have compared the pattern of "bilateral" LG involvement with "unilateral" LG involvement data of their region.

The discussion implies that there are two main articles about the characteristics of bilateral LG involvement (by Huang et al in Australia and Tang et al in the US). A more detailed comparison of the findings of the present study with the two other similar case series would have been more informative.

Finally, as the authors have mentioned, the differences in the design of these studies prevent drawing conclusions from such comparison as, for instance, the IgG4 level testing may have been inconsistent among these studies. In this manuscript, only 31 of the 113 cases were tested for serum igG4 levels.

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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.

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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 #2: Yes: Prof. Hind M Alkatan

Reviewer #4: No

Reviewer #5: 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.

PONE-D-23-44008R2Clinicopathologic features and outcomes of bilateral lacrimal gland lesionsPLOS ONE

Dear Dr. He,

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:  The manuscript was improved by the Authors, however the paper still needs minor revision. Please check the comments of the Reviewer and make the necessary correction.

==============================

Please submit your revised manuscript by Jul 17 2024 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,

Karolina Goździewska-Harłajczuk

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:

The manuscript was improved by the Authors, however the paper still needs minor revision. Please check the comments of the Reviewer and make the necessary correction.

[Note: HTML markup is below. Please do not edit.]

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: All comments have been addressed

Reviewer #5: (No Response)

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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: Yes

Reviewer #5: Yes

**********

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

Reviewer #1: Yes

Reviewer #5: 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 #5: 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 #5: 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 reviewer's comments have been addressed adequately and the manuscript is now suitable for publication

Reviewer #5: The revised paper is relatively improved and it has merit because of scarcity of similar studies conducted in its corresponding region (west China). However, the reader cannot find out how the "bilateral" lacrimal gland disorders compare to "unilateral" lacrimal gland involvement. So, I recommend the authors to present a very clear comparison between the two.

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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 #5: 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.

Clinicopathologic features and outcomes of bilateral lacrimal gland lesions

PONE-D-23-44008R3

Dear Dr. He,

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.

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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,

Karolina Goździewska-Harłajczuk

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All the corrections were included within the revised version of the manuscript.

Reviewers' comments: