Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy - 24/08/11
Reprint requests: Michael B Wallace, MD, MPH, Professor of Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, CLE, IEN, NBI, pCLE
Plan
| DISCLOSURE: M. Wallace disclosed educational support below the level of federal reporting from Mauna Kea Technologies, P. Sharma disclosed an unspecified relationship with Mauna Kea Technologies, and C. Lightdale disclosed a consultant relationship with Olympus, America. All other authors disclosed no financial relationships relevant to this publication. |
Vol 72 - N° 1
P. 19-24 - juillet 2010 Retour au numéro
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