Expert assessment on volumetric laser endomicroscopy full scans in Barrett's esophagus patients with or without high grade dysplasia or early cancer.
Endoscopy
; 53(3): 218-225, 2021 03.
Article
en En
| MEDLINE
| ID: mdl-32515006
ABSTRACT
BACKGROUND:
Volumetric laser endomicroscopy (VLE) allows for near-microscopic imaging of the superficial esophageal wall and may improve detection of early neoplasia in Barrett's esophagus (BE). Interpretation of a 6-cm long, circumferential VLE "full scan" may however be challenging for endoscopists. We aimed to evaluate the accuracy of VLE experts in correctly diagnosing VLE full scans of early neoplasia and non-dysplastic BE (NDBE).METHODS:
29 VLE full scan videos (15 neoplastic and 14 NDBE) were randomly evaluated by 12 VLE experts using a web-based module. Experts were blinded to the endoscopic BE images and histology. The 15 neoplastic cases contained a subtle endoscopically visible lesion, which on endoscopic resection showed high grade dysplasia or cancer. NDBE cases had no visible lesions and an absence of dysplasia in all biopsies. VLE videos were first scored as "neoplastic" or "NDBE." If neoplastic, assessors located the area most suspicious for neoplasia. Primary outcome was the performance of VLE experts in differentiating between non-dysplastic and neoplastic full scan videos, calculated by accuracy, sensitivity, and specificity. Secondary outcomes included correct location of neoplasia, interobserver agreement, and level of confidence.RESULTS:
VLE experts correctly labelled 73â% (95â% confidence interval [CI] 67â%â-â79â%) of neoplastic VLE videos. In 54â% (range 27â%â-â66â%) both neoplastic diagnosis and lesion location were correct. NDBE videos were consistent with endoscopic biopsies in 52â% (95â%CI 46â%â-â57â%). Interobserver agreement was fair (kappa 0.28). High level of confidence was associated with a higher rate of correct neoplastic diagnosis (81â%) and lesion location (73â%).CONCLUSIONS:
Identification of subtle neoplastic lesions in VLE full scans by experts was disappointing. Future studies should focus on improving methodologies for reviewing full scans, development of refined VLE criteria for neoplasia, and computer-aided diagnosis of VLE scans.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Esófago de Barrett
/
Neoplasias Esofágicas
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
Endoscopy
Año:
2021
Tipo del documento:
Article
País de afiliación:
Países Bajos