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Narrow-band imaging with magnification in Barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology.
Endoscopy. 2008 Jun; 40(6):457-63.E

Abstract

BACKGROUND AND STUDY AIMS

Validation of a simplified classification of mucosal morphology in prediction of histology in Barrett's esophagus using narrow-band imaging with magnification (NBI-Z) and assessing its reproducibility by endoscopists experienced in the use of NBI (NBI-experts) and by endoscopists who were new to NBI (non-NBI-experts).

PATIENTS AND METHODS

In a prospective cohort study of 109 patients with Barrett's esophagus at a single tertiary referral center, mucosal patterns visualized in Barrett's esophagus on NBI-Z were classified into four easily distinguishable types: A, round pits with regular microvasculature; B, villous/ridge pits with regular microvasculature; C, absent pits with regular microvasculature; D, distorted pits with irregular microvasculature. The NBI-Z grading was compared with the final histopathological diagnosis, and positive (PPV) and negative predictive values (NPV) were calculated. The reproducibility of the grading was then assessed by NBI-expert and non-NBI-expert endoscopists, and interobserver and intraobserver agreement were calculated using kappa statistics.

RESULTS

Per-biopsy analysis: In 903 out of 1021 distinct areas (87.9%) the NBI-Z grading corresponded to the histological diagnosis. Per-patient analysis: The PPV and NPV for type A pattern (columnar mucosa without intestinal metaplasia) were 100% and 97% respectively; for types B and C (intestinal metaplasia) they were 88% and 91% respectively, and for type D (high-grade dysplasia) 81% and 99% respectively. Inter- and intraobserver agreement: The mean kappa values in assessing the various patterns were 0.71 and 0.87 in the non-expert group; 0.78 and 0.91 in the expert group.

CONCLUSIONS

This study has validated a simplified classification of the various morphologic patterns visualized in Barrett's esophagus and confirmed its reproducibility when used by NBI-expert and non-NBI-expert endoscopists.

Authors+Show Affiliations

Wolfson Digestive Diseases Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

18459090

Citation

Singh, R, et al. "Narrow-band Imaging With Magnification in Barrett's Esophagus: Validation of a Simplified Grading System of Mucosal Morphology Patterns Against Histology." Endoscopy, vol. 40, no. 6, 2008, pp. 457-63.
Singh R, Anagnostopoulos GK, Yao K, et al. Narrow-band imaging with magnification in Barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy. 2008;40(6):457-63.
Singh, R., Anagnostopoulos, G. K., Yao, K., Karageorgiou, H., Fortun, P. J., Shonde, A., Garsed, K., Kaye, P. V., Hawkey, C. J., & Ragunath, K. (2008). Narrow-band imaging with magnification in Barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy, 40(6), 457-63. https://doi.org/10.1055/s-2007-995741
Singh R, et al. Narrow-band Imaging With Magnification in Barrett's Esophagus: Validation of a Simplified Grading System of Mucosal Morphology Patterns Against Histology. Endoscopy. 2008;40(6):457-63. PubMed PMID: 18459090.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Narrow-band imaging with magnification in Barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. AU - Singh,R, AU - Anagnostopoulos,G K, AU - Yao,K, AU - Karageorgiou,H, AU - Fortun,P J, AU - Shonde,A, AU - Garsed,K, AU - Kaye,P V, AU - Hawkey,C J, AU - Ragunath,K, Y1 - 2008/05/06/ PY - 2008/5/7/pubmed PY - 2008/8/15/medline PY - 2008/5/7/entrez SP - 457 EP - 63 JF - Endoscopy JO - Endoscopy VL - 40 IS - 6 N2 - BACKGROUND AND STUDY AIMS: Validation of a simplified classification of mucosal morphology in prediction of histology in Barrett's esophagus using narrow-band imaging with magnification (NBI-Z) and assessing its reproducibility by endoscopists experienced in the use of NBI (NBI-experts) and by endoscopists who were new to NBI (non-NBI-experts). PATIENTS AND METHODS: In a prospective cohort study of 109 patients with Barrett's esophagus at a single tertiary referral center, mucosal patterns visualized in Barrett's esophagus on NBI-Z were classified into four easily distinguishable types: A, round pits with regular microvasculature; B, villous/ridge pits with regular microvasculature; C, absent pits with regular microvasculature; D, distorted pits with irregular microvasculature. The NBI-Z grading was compared with the final histopathological diagnosis, and positive (PPV) and negative predictive values (NPV) were calculated. The reproducibility of the grading was then assessed by NBI-expert and non-NBI-expert endoscopists, and interobserver and intraobserver agreement were calculated using kappa statistics. RESULTS: Per-biopsy analysis: In 903 out of 1021 distinct areas (87.9%) the NBI-Z grading corresponded to the histological diagnosis. Per-patient analysis: The PPV and NPV for type A pattern (columnar mucosa without intestinal metaplasia) were 100% and 97% respectively; for types B and C (intestinal metaplasia) they were 88% and 91% respectively, and for type D (high-grade dysplasia) 81% and 99% respectively. Inter- and intraobserver agreement: The mean kappa values in assessing the various patterns were 0.71 and 0.87 in the non-expert group; 0.78 and 0.91 in the expert group. CONCLUSIONS: This study has validated a simplified classification of the various morphologic patterns visualized in Barrett's esophagus and confirmed its reproducibility when used by NBI-expert and non-NBI-expert endoscopists. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/18459090/Narrow_band_imaging_with_magnification_in_Barrett's_esophagus:_validation_of_a_simplified_grading_system_of_mucosal_morphology_patterns_against_histology_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-995741 DB - PRIME DP - Unbound Medicine ER -