CLEAR item#4
“Scientific or clinical background. Define the scientific or clinical problem with a summary of the related literature and knowledge gaps, including a short review of the current state of knowledge. Describe why the scientific question is technically or clinically important.” [1] (from the article by Kocak et al.; licensed under CC BY 4.0)
Reporting examples for CLEAR item#4
Example#1. “Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy (10–15%) after hepatocellular carcinoma, with an increasing incidence and mortality globally. Surgical resection is a curative option for ICC. However, most patients (70%) are diagnosed at advanced stages with unresectable tumors due to a lack of specific symptoms, resulting in a dismal prognosis, with a median survival shorter than 12 months, and high risk of recurrence and metastasis after operation also lead to the poor prognosis. Nowadays, the prognosis prediction of ICC depends on the conventional prognostic factors used in clinical practice such as tumor stage and lymph node status, which is not sufficient for accurate stratification in many cases. Currently, many studies have attempted to find risk factors of prognosis, but the clinical application value was limited. Accurate identification of recurrence risk factors of ICC is conducive to stratified management and individualized treatment.
The characteristic identification of poor prognosis in cholangiocarcinoma has been transited to the cellular and molecular levels, and it is generally featured by a highly desmoplastic tumor microenvironment (TME) with excessively infiltrating immune and stromal cells. Recently, ectopic aggregates of immune cells with similarities to secondary lymphoid organs (SLO), named tumor-associated tertiary lymphoid structures (TLSs), have attracted extensive attention because of their potential prognostic value and guiding significance of immunotherapy. Ding et al. reported that intra-tumor region TLSs were positively correlated with favorable prognosis whereas peri-tumor region signified worse survival, and performance of the immune classification for ICC was superior to TNM staging system. Zhang et al. demonstrated that the presence of intra-tumoral TLSs was correlated with a good recurrence-free survival (RFS) outcome of perihilar cholangiocarcinoma but not with overall survival (OS).” [2] (from the article by Xu et al.; licensed under CC BY 4.0)
Example#2. “Pericardial adipose tissue (PAT) is the visceral adipose tissue compartment surrounding the heart and coronary vasculature. An increasing body of evidence highlights associations between greater amounts of PAT and poorer cardiovascular outcomes. Furthermore, higher PAT has been linked to adverse cardiovascular phenotypes, independent of multiple other measures of adiposity. These associations are highly suggestive of a distinct mechanistic role of PAT in driving adverse cardiac remodelling, which are precursors of heart failure.
The mechanisms through which PAT influences myocardial structure and function are likely multifactorial, involving paracrine, vasocrine, and inflammatory pathways. PAT is known to secrete inflammatory factors and lipid metabolites, and this metabolic and secretory activity has been highlighted as an important factor driving adverse cardiovascular outcomes. At a cellular level, the secretome of PAT has been shown to adversely impact cardiomyocyte contractility, metabolism, and disrupt adhesion molecule expression in cardiac endothelial cells. In the setting of ischemic heart disease, patterns of coronary atherosclerosis have been shown to closely follow superficial PAT distribution. Thus, existing evidence suggests that both the amount and character of PAT are important in determining its pathogenicity.” [3] (from the article by Szabo et al.; licensed under CC BY 4.0)
Explanation and elaboration of CLEAR item#4
This comprehensive step integrates the existing literature, identifies knowledge gaps, and emphasizes the question’s technical or clinical significance. Summary of relevant studies provides a foundation and identifies gaps in understanding. Literature gaps must be identified. To identify areas for further research, previous studies must be assessed for methodology, findings, and relevant limitations. A technical or clinically significant scientific question is key to presenting the importance of the project and should have real-world implications. Both Example#1 and Example#2 introduce the medical condition of interest and the scientific problem in the first paragraph, while the second paragraph provides further literature-based insights into their nature.
References
- Kocak B, Baessler B, Bakas S, et al (2023) CheckList for EvaluAtion of Radiomics research (CLEAR): a step-by-step reporting guideline for authors and reviewers endorsed by ESR and EuSoMII. Insights Imaging 14:75. https://doi.org/10.1186/s13244-023-01415-8
- Xu Y, Li Z, Yang Y, et al (2023) A CT-based radiomics approach to predict intra-tumoral tertiary lymphoid structures and recurrence of intrahepatic cholangiocarcinoma. Insights Imaging 14:173. https://doi.org/10.1186/s13244-023-01527-1
- Szabo L, Salih A, Pujadas ER, et al (2023) Radiomics of pericardial fat: a new frontier in heart failure discrimination and prediction. Eur Radiol. https://doi.org/10.1007/s00330-023-10311-0