Accuracy and interrater reliability for the diagnosis of Barrett's neoplasia among users of a novel, portable high-resolution microendoscope. Issue 1 (1st January 2014)

• Record Type: Journal Article
• Authors: Vila, P. M.; Kingsley, M. J.; Polydorides, A. D.; Protano, M.-A.; Pierce, M. C.; Sauk, J.; Kim, M. K.; Patel, K.; Godbold, J. H.; Waye, J. D.; Richards-Kortum, R.; Anandasabapathy, S.
• Is Part Of: Diseases of the esophagus. Volume 27:Issue 1(2014)
• Page Start: 55
• Page End: 62
• Publication Date: 2014-01-01
• Subjects: cancer -- diagnostic imaging -- esophagogastroduodenoscopy -- optical device; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1111/dote.12040
• Languages: English
• ISSNs: 1120-8694

Abstract

Summary: The high-resolution microendoscope (HRME) is a novel imaging modality that may be useful in the surveillance of Barrett's esophagus in low-resource or community-based settings. In order to assess accuracy and interrater reliability of microendoscopists in identifying Barrett's-associated neoplasia using HRME images, we recruited 20 gastroenterologists with no microendoscopic experience and three expert microendoscopists in a large academic hospital in New York City to interpret HRME images. They prospectively reviewed 40 HRME images from 28 consecutive patients undergoing surveillance for metaplasia and low-grade dysplasia and/or evaluation for high-grade dysplasia or cancer. Images were reviewed in a blinded fashion, after a 4-minute training with 11 representative images. All imaged sites were biopsied and interpreted by an expert pathologist. Sensitivity of all endoscopists for identification of high-grade dysplasia or cancer was 0.90 (95% confidence interval [CI]: 0.88-0.92) and specificity was 0.82 (95% CI: 0.79-0.85). Positive and negative predictive values were 0.72 (95% CI: 0.68-0.77) and 0.94 (95% CI: 0.92-0.96), respectively. No significant differences in accuracy were observed between experts and novices (0.90 vs. 0.84). The kappa statistic for all raters was 0.56 (95% CI: 0.54-0.58), and the difference between groups was not significant (0.64 vs. 0.55). These data suggest that gastroenterologists can diagnose Barrett's-related neoplasia on HRME images with high sensitivity and specificity, without the aid of prior microendoscopy experience.