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Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett's esophagus-associated neoplasia.
Gastrointest Endosc 2019; 89(2):247-256.e4GE

Abstract

BACKGROUND AND AIMS

The Seattle protocol for endoscopic Barrett's esophagus (BE) surveillance samples a small portion of the mucosal surface area, risking a potentially high miss rate of early neoplastic lesions. We assessed whether the new iScan Optical Enhancement system (OE) improves the detection of early BE-associated neoplasia compared with high-definition white-light endoscopy (HD-WLE) in both expert and trainee endoscopists to target sampling of suspicious areas. Such a system may both improve early neoplasia detection and reduce the need for random biopsies.

METHODS

A total of 41 patients undergoing endoscopic BE surveillance from January 2016 to November 2017 were recruited from 3 international referral centers. Matched still images in both HD-WLE (n = 130) and iScan OE (n = 132) were obtained from endoscopic examinations. Two experts, unblinded to the videos and histology, delineated known neoplasia, forming a consensus criterion standard. Seven expert and 7 trainee endoscopists marked 1 position per image where they would expect a target biopsy to identify dysplastic tissue. The same expert panel then reviewed magnification images and, using a previously validated classification system, attempted to classify mucosa as dysplastic or nondysplastic, based on the mucosal and vascular (MV) patterns observed on magnification endoscopy. Diagnostic accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Improvements in dysplasia detection in HD-WLE versus OE and interobserver agreement were assessed by multilevel logistic regression analysis and Krippendorff alpha, respectively. Improvements in diagnostic performance were expressed as an odds ratio between the odds of improvement in OE compared with the odds of improvement in HD-WLE.

RESULTS

Accuracy of neoplasia detection was significantly higher in all trainees who used OE versus HD-WLE (76% vs 63%) and in 6 experts (84% vs 77%). OE improved sensitivity of dysplasia detection compared with HD-WLE in 6 trainees (81% vs 71%) and 5 experts (77% vs 67%). Specificity improved in 6 trainees who used OE versus HD-WLE (70% vs 55%) and in 5 experts (92% vs 86%). PPV improved in both an expert and trainee cohort, but NPV improved significantly only in trainees. By using the MV classification and OE magnification endoscopy compared with HD-WLE, we demonstrated improvements in accuracy (79.9% vs 66.7%), sensitivity (86.3% vs 83.4%), and specificity (71.2% vs 53.6%) of dysplasia detection. PPV improved (62%-76.6%), as did NPV (67.7%-78.5%). Interobserver agreement also improved by using OE from 0.30 to 0.55.

CONCLUSION

iScan OE may improve dysplasia detection on endoscopic imaging of BE as well as the accuracy of histology prediction compared with HD-WLE, when OE magnification endoscopy is used in conjunction with a simple classification system by both expert and non-expert endoscopists.

Authors+Show Affiliations

Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.StatsCounsultancy Ltd, Amersham, Buckinghamshire.Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, NHS Trust, Nottingham, England.Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.Hospital Clínico San Carlos, Madrid, Spain.NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, NHS Trust, Nottingham, England.Universitaire Ziekenhuizen Leuven, Leuven, Belgium.Division of Surgery and Interventional Science, University College London, London; Department of Gastroenterology, University College Hospital NHS Foundation Trust, London.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30291849

Citation

Everson, Martin A., et al. "Virtual Chromoendoscopy By Using Optical Enhancement Improves the Detection of Barrett's Esophagus-associated Neoplasia." Gastrointestinal Endoscopy, vol. 89, no. 2, 2019, pp. 247-256.e4.
Everson MA, Lovat LB, Graham DG, et al. Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett's esophagus-associated neoplasia. Gastrointest Endosc. 2019;89(2):247-256.e4.
Everson, M. A., Lovat, L. B., Graham, D. G., Bassett, P., Magee, C., Alzoubaidi, D., ... Haidry, R. J. (2019). Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett's esophagus-associated neoplasia. Gastrointestinal Endoscopy, 89(2), pp. 247-256.e4. doi:10.1016/j.gie.2018.09.032.
Everson MA, et al. Virtual Chromoendoscopy By Using Optical Enhancement Improves the Detection of Barrett's Esophagus-associated Neoplasia. Gastrointest Endosc. 2019;89(2):247-256.e4. PubMed PMID: 30291849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett's esophagus-associated neoplasia. AU - Everson,Martin A, AU - Lovat,Laurence B, AU - Graham,David G, AU - Bassett,Paul, AU - Magee,Cormac, AU - Alzoubaidi,Durayd, AU - Fernández-Sordo,Jacobo O, AU - Sweis,Rami, AU - Banks,Matthew R, AU - Wani,Sachin, AU - Esteban,Jose M, AU - Ragunath,Krish, AU - Bisschops,Raf, AU - Haidry,Rehan J, Y1 - 2018/10/03/ PY - 2018/04/19/received PY - 2018/09/24/accepted PY - 2018/10/7/pubmed PY - 2019/5/22/medline PY - 2018/10/7/entrez SP - 247 EP - 256.e4 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 89 IS - 2 N2 - BACKGROUND AND AIMS: The Seattle protocol for endoscopic Barrett's esophagus (BE) surveillance samples a small portion of the mucosal surface area, risking a potentially high miss rate of early neoplastic lesions. We assessed whether the new iScan Optical Enhancement system (OE) improves the detection of early BE-associated neoplasia compared with high-definition white-light endoscopy (HD-WLE) in both expert and trainee endoscopists to target sampling of suspicious areas. Such a system may both improve early neoplasia detection and reduce the need for random biopsies. METHODS: A total of 41 patients undergoing endoscopic BE surveillance from January 2016 to November 2017 were recruited from 3 international referral centers. Matched still images in both HD-WLE (n = 130) and iScan OE (n = 132) were obtained from endoscopic examinations. Two experts, unblinded to the videos and histology, delineated known neoplasia, forming a consensus criterion standard. Seven expert and 7 trainee endoscopists marked 1 position per image where they would expect a target biopsy to identify dysplastic tissue. The same expert panel then reviewed magnification images and, using a previously validated classification system, attempted to classify mucosa as dysplastic or nondysplastic, based on the mucosal and vascular (MV) patterns observed on magnification endoscopy. Diagnostic accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Improvements in dysplasia detection in HD-WLE versus OE and interobserver agreement were assessed by multilevel logistic regression analysis and Krippendorff alpha, respectively. Improvements in diagnostic performance were expressed as an odds ratio between the odds of improvement in OE compared with the odds of improvement in HD-WLE. RESULTS: Accuracy of neoplasia detection was significantly higher in all trainees who used OE versus HD-WLE (76% vs 63%) and in 6 experts (84% vs 77%). OE improved sensitivity of dysplasia detection compared with HD-WLE in 6 trainees (81% vs 71%) and 5 experts (77% vs 67%). Specificity improved in 6 trainees who used OE versus HD-WLE (70% vs 55%) and in 5 experts (92% vs 86%). PPV improved in both an expert and trainee cohort, but NPV improved significantly only in trainees. By using the MV classification and OE magnification endoscopy compared with HD-WLE, we demonstrated improvements in accuracy (79.9% vs 66.7%), sensitivity (86.3% vs 83.4%), and specificity (71.2% vs 53.6%) of dysplasia detection. PPV improved (62%-76.6%), as did NPV (67.7%-78.5%). Interobserver agreement also improved by using OE from 0.30 to 0.55. CONCLUSION: iScan OE may improve dysplasia detection on endoscopic imaging of BE as well as the accuracy of histology prediction compared with HD-WLE, when OE magnification endoscopy is used in conjunction with a simple classification system by both expert and non-expert endoscopists. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/30291849/Virtual_chromoendoscopy_by_using_optical_enhancement_improves_the_detection_of_Barrett's_esophagus_associated_neoplasia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(18)33144-4 DB - PRIME DP - Unbound Medicine ER -