Jeff Chang1, Matthew Ip1, Michael Yang1, Brendon Wong1, Theresa Power2, Lisa Lin2, Wei Xuan3, Tri Giang Phan4, Rupert W Leong5. 1. Gastroenterology and Liver Services, Bankstown Hospital, Sydney South West Local Health District, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia. 2. Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia; Faculty of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia. 3. Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia. 4. Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Immunology Division, The Garvan Institute of Medical Research, Sydney, New South Wales, Australia. 5. Gastroenterology and Liver Services, Bankstown Hospital, Sydney South West Local Health District, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Immunology Division, The Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
Abstract
BACKGROUND AND AIMS: Confocal laser endomicroscopy can dynamically assess intestinal mucosal barrier defects and increased intestinal permeability (IP). These are functional features that do not have corresponding appearance on histopathology. As such, previous pathology training may not be beneficial in learning these dynamic features. This study aims to evaluate the diagnostic accuracy, learning curve, inter- and intraobserver agreement for identifying features of increased IP in experienced and inexperienced analysts and pathologists. METHODS: A total of 180 endoscopic confocal laser endomicroscopy (Pentax EC-3870FK; Pentax, Tokyo, Japan) images of the terminal ileum, subdivided into 6 sets of 30 were evaluated by 6 experienced analysts, 13 inexperienced analysts, and 2 pathologists, after a 30-minute teaching session. Cell-junction enhancement, fluorescein leak, and cell dropout were used to represent increased IP and were either present or absent in each image. For each image, the diagnostic accuracy, confidence, and quality were assessed. RESULTS: Diagnostic accuracy was significantly higher for experienced analysts compared with inexperienced analysts from the first set (96.7% vs 83.1%, P < .001) to the third set (95% vs 89.7, P = .127). No differences in accuracy were noted between inexperienced analysts and pathologists. Confidence (odds ratio, 8.71; 95% confidence interval, 5.58-13.57) and good image quality (odds ratio, 1.58; 95% confidence interval, 1.22-2.03) were associated with improved interpretation. Interobserver agreement κ values were high and improved with experience (experienced analysts, 0.83; inexperienced analysts, 0.73; and pathologists, 0.62). Intraobserver agreement was >0.86 for experienced observers. CONCLUSION: Features representative of increased IP can be rapidly learned with high inter- and intraobserver agreement. Confidence and image quality were significant predictors of accurate interpretation. Previous pathology training did not have an effect on learning.
BACKGROUND AND AIMS: Confocal laser endomicroscopy can dynamically assess intestinal mucosal barrier defects and increased intestinal permeability (IP). These are functional features that do not have corresponding appearance on histopathology. As such, previous pathology training may not be beneficial in learning these dynamic features. This study aims to evaluate the diagnostic accuracy, learning curve, inter- and intraobserver agreement for identifying features of increased IP in experienced and inexperienced analysts and pathologists. METHODS: A total of 180 endoscopic confocal laser endomicroscopy (Pentax EC-3870FK; Pentax, Tokyo, Japan) images of the terminal ileum, subdivided into 6 sets of 30 were evaluated by 6 experienced analysts, 13 inexperienced analysts, and 2 pathologists, after a 30-minute teaching session. Cell-junction enhancement, fluorescein leak, and cell dropout were used to represent increased IP and were either present or absent in each image. For each image, the diagnostic accuracy, confidence, and quality were assessed. RESULTS: Diagnostic accuracy was significantly higher for experienced analysts compared with inexperienced analysts from the first set (96.7% vs 83.1%, P < .001) to the third set (95% vs 89.7, P = .127). No differences in accuracy were noted between inexperienced analysts and pathologists. Confidence (odds ratio, 8.71; 95% confidence interval, 5.58-13.57) and good image quality (odds ratio, 1.58; 95% confidence interval, 1.22-2.03) were associated with improved interpretation. Interobserver agreement κ values were high and improved with experience (experienced analysts, 0.83; inexperienced analysts, 0.73; and pathologists, 0.62). Intraobserver agreement was >0.86 for experienced observers. CONCLUSION: Features representative of increased IP can be rapidly learned with high inter- and intraobserver agreement. Confidence and image quality were significant predictors of accurate interpretation. Previous pathology training did not have an effect on learning.
Authors: Yunki Y Yau; Valerie C Wasinger; Robert P Hirten; Emil Chuang; Merodean Huntsman; Jack Stylli; Jeff Shimizu; Vijay Yajnik; Jeffrey Smith; Shaoying N Lee; Sharat Singh; Christopher Wahl; Rupert W Leong; Bruce E Sands Journal: Inflamm Bowel Dis Date: 2021-11-15 Impact factor: 7.290
Authors: Maximilian J Waldner; Timo Rath; Sebastian Schürmann; Christian Bojarski; Raja Atreya Journal: Front Immunol Date: 2017-10-11 Impact factor: 7.561
Authors: Bojan Kovacevic; Giulio Antonelli; Pia Klausen; Cesare Hassan; Alberto Larghi; Peter Vilmann; John Gásdal Karstensen Journal: Endosc Ultrasound Date: 2021 Jul-Aug Impact factor: 5.628