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Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy.
Gastrointest Endosc. 2010 Jul; 72(1):19-24.GE

Abstract

BACKGROUND

Confocal laser endomicroscopy (CLE) is a rapidly emerging method for in vivo imaging of the GI tract.

OBJECTIVE

To determine the preliminary evaluation accuracy and interobserver agreement of probe-based CLE (pCLE) in Barrett's esophagus (BE).

DESIGN

Prospective, double-blind review of pCLE images of 40 sites of BE tissue by using matching biopsies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 20 unknown images.

SETTING

Eleven experts in BE imaging from 4 different endoscopy centers from the United States and Europe evaluated the images.

PATIENTS

This study involved nonconsecutive patients undergoing BE surveillance or evaluation of high-grade intraepithelial neoplasia or early adenocarcinoma.

INTERVENTION

Intravenous fluorescein pCLE imaging of each site within the BE segment, followed by matching biopsy.

MAIN OUTCOME MEASUREMENTS

Sensitivity, specificity, and agreement for the pCLE diagnosis of high-grade intraepithelial neoplasia or carcinoma.

RESULTS

In the validation set (n = 20), 11 cases had high-grade intraepithelial neoplasia or invasive carcinoma. The sensitivity for the diagnosis of neoplasia for the 11 endoscopists was 88% (range 6 of 11 to 11 of 11), and the specificity was 96% (range 7 of 9 to 9 of 9). There was substantial agreement on the pCLE diagnosis (86%, kappa 0.72; 95% confidence interval, 0.58-0.86). Endomicroscopists with prior pCLE experience had an overall sensitivity of 91% (all 10 of 11), specificity of 100% (all 9 of 9), and almost perfect agreement (92%, kappa 0.83; 95% confidence interval, 0.64-1.0).

LIMITATIONS

Small sample size and use of offline video sequences.

CONCLUSION

Results suggest that pCLE for the diagnosis of neoplasia in BE has very high accuracy and reliability.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20381042

Citation

Wallace, Michael B., et al. "Preliminary Accuracy and Interobserver Agreement for the Detection of Intraepithelial Neoplasia in Barrett's Esophagus With Probe-based Confocal Laser Endomicroscopy." Gastrointestinal Endoscopy, vol. 72, no. 1, 2010, pp. 19-24.
Wallace MB, Sharma P, Lightdale C, et al. Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy. Gastrointest Endosc. 2010;72(1):19-24.
Wallace, M. B., Sharma, P., Lightdale, C., Wolfsen, H., Coron, E., Buchner, A., Bajbouj, M., Bansal, A., Rastogi, A., Abrams, J., Crook, J. E., & Meining, A. (2010). Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy. Gastrointestinal Endoscopy, 72(1), 19-24. https://doi.org/10.1016/j.gie.2010.01.053
Wallace MB, et al. Preliminary Accuracy and Interobserver Agreement for the Detection of Intraepithelial Neoplasia in Barrett's Esophagus With Probe-based Confocal Laser Endomicroscopy. Gastrointest Endosc. 2010;72(1):19-24. PubMed PMID: 20381042.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy. AU - Wallace,Michael B, AU - Sharma,Prateek, AU - Lightdale,Charles, AU - Wolfsen,Herbert, AU - Coron,Emmanuel, AU - Buchner,Anna, AU - Bajbouj,Monther, AU - Bansal,Ajay, AU - Rastogi,Amit, AU - Abrams,Julian, AU - Crook,Julia E, AU - Meining,Alexander, Y1 - 2010/04/08/ PY - 2009/07/28/received PY - 2010/01/22/accepted PY - 2010/4/13/entrez PY - 2010/4/13/pubmed PY - 2010/11/3/medline SP - 19 EP - 24 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 72 IS - 1 N2 - BACKGROUND: Confocal laser endomicroscopy (CLE) is a rapidly emerging method for in vivo imaging of the GI tract. OBJECTIVE: To determine the preliminary evaluation accuracy and interobserver agreement of probe-based CLE (pCLE) in Barrett's esophagus (BE). DESIGN: Prospective, double-blind review of pCLE images of 40 sites of BE tissue by using matching biopsies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 20 unknown images. SETTING: Eleven experts in BE imaging from 4 different endoscopy centers from the United States and Europe evaluated the images. PATIENTS: This study involved nonconsecutive patients undergoing BE surveillance or evaluation of high-grade intraepithelial neoplasia or early adenocarcinoma. INTERVENTION: Intravenous fluorescein pCLE imaging of each site within the BE segment, followed by matching biopsy. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, and agreement for the pCLE diagnosis of high-grade intraepithelial neoplasia or carcinoma. RESULTS: In the validation set (n = 20), 11 cases had high-grade intraepithelial neoplasia or invasive carcinoma. The sensitivity for the diagnosis of neoplasia for the 11 endoscopists was 88% (range 6 of 11 to 11 of 11), and the specificity was 96% (range 7 of 9 to 9 of 9). There was substantial agreement on the pCLE diagnosis (86%, kappa 0.72; 95% confidence interval, 0.58-0.86). Endomicroscopists with prior pCLE experience had an overall sensitivity of 91% (all 10 of 11), specificity of 100% (all 9 of 9), and almost perfect agreement (92%, kappa 0.83; 95% confidence interval, 0.64-1.0). LIMITATIONS: Small sample size and use of offline video sequences. CONCLUSION: Results suggest that pCLE for the diagnosis of neoplasia in BE has very high accuracy and reliability. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/20381042/Preliminary_accuracy_and_interobserver_agreement_for_the_detection_of_intraepithelial_neoplasia_in_Barrett's_esophagus_with_probe_based_confocal_laser_endomicroscopy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(10)00126-4 DB - PRIME DP - Unbound Medicine ER -