Wen-Lun Wang1, Sherry Yueh-Hsia Chiu2,3, Ching-Tai Lee1, Cheng-Hao Tseng1, Chien-Chuan Chen4, Ming-Lun Han5, Chen-Shuan Chung6, Ping-Hsin Hsieh7, Wei-Lun Chang8, Ping-Hsiu Wu9, Wen-Hung Hsu10, Hsu-Heng Yen11, Hsiu-Po Wang4, Chi-Yang Chang1,12,13. 1. Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan. 2. Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. 3. Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 4. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 5. Department of Internal Medicine, Min-Sheng General Hospital, Taoyan, Taiwan. 6. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. 7. Department of Gastroenterology, Chimei Medical Center, Tainan, Taiwan. 8. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. 9. Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. 10. Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 11. Endoscopy Center, Changhua Christian Hospital, Changhua, Taiwan. 12. School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. 13. Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
Abstract
BACKGROUND AND AIM: Optimal staging of the invasion depth of superficial esophageal squamous cell carcinoma is vital before endoscopic treatment. A new simplified magnified narrow-band imaging (M-NBI) classification system based on vascular architecture has recently been developed by the Japan Esophageal Society; however, its validity remains uncertain. METHODS: A total of 11 experienced and 11 inexperienced endoscopists were invited to join an endoscopic training program, which was composed of pretest, educational section, and post-test. The pretest and post-test sections included a set of endoscopic photos from 40 subjects with superficial esophageal squamous cell carcinoma with various invasion depths. Each subject appeared twice in the test, one with white-light imaging (WLI) only and the other with both WLI and M-NBI. The educational section included lectures and video demonstrations. RESULTS: The accuracy of WLI alone and combined with M-NBI at baseline were 0.53, 0.57 and 0.43, 0.41 for the experienced and inexperienced endoscopists, respectively, which then improved to 0.57, 0.63 and 0.49, 0.52 after training. Inter-observer agreement (k-value) of WLI alone and combined WLI and M-NBI for the experienced and inexperienced endoscopists also improved from 0.61, 0.61, and 0.61, 0.53 to 0.68, 0.71, and 0.71, 0.59, respectively. Multivariate analysis revealed that the educational course but not experience in endoscopy, NBI, or magnification significantly improved the diagnostic accuracy. M-NBI had a significant additional benefit to WLI, with an improvement in accuracy from 36% to 56% for the cases with m3/sm1 cancers (P < 0.05). CONCLUSIONS: A well-designed training program can improve the diagnostic accuracy in evaluating cancer invasion depth, with substantial agreement.
BACKGROUND AND AIM: Optimal staging of the invasion depth of superficial esophageal squamous cell carcinoma is vital before endoscopic treatment. A new simplified magnified narrow-band imaging (M-NBI) classification system based on vascular architecture has recently been developed by the Japan Esophageal Society; however, its validity remains uncertain. METHODS: A total of 11 experienced and 11 inexperienced endoscopists were invited to join an endoscopic training program, which was composed of pretest, educational section, and post-test. The pretest and post-test sections included a set of endoscopic photos from 40 subjects with superficial esophageal squamous cell carcinoma with various invasion depths. Each subject appeared twice in the test, one with white-light imaging (WLI) only and the other with both WLI and M-NBI. The educational section included lectures and video demonstrations. RESULTS: The accuracy of WLI alone and combined with M-NBI at baseline were 0.53, 0.57 and 0.43, 0.41 for the experienced and inexperienced endoscopists, respectively, which then improved to 0.57, 0.63 and 0.49, 0.52 after training. Inter-observer agreement (k-value) of WLI alone and combined WLI and M-NBI for the experienced and inexperienced endoscopists also improved from 0.61, 0.61, and 0.61, 0.53 to 0.68, 0.71, and 0.71, 0.59, respectively. Multivariate analysis revealed that the educational course but not experience in endoscopy, NBI, or magnification significantly improved the diagnostic accuracy. M-NBI had a significant additional benefit to WLI, with an improvement in accuracy from 36% to 56% for the cases with m3/sm1 cancers (P < 0.05). CONCLUSIONS: A well-designed training program can improve the diagnostic accuracy in evaluating cancer invasion depth, with substantial agreement.
Authors: M Everson; Lcgp Herrera; W Li; I Muntion Luengo; O Ahmad; M Banks; C Magee; D Alzoubaidi; H M Hsu; D Graham; T Vercauteren; L Lovat; S Ourselin; S Kashin; Hsiu-Po Wang; Wen-Lun Wang; R J Haidry Journal: United European Gastroenterol J Date: 2019-01-06 Impact factor: 4.623