Hiroto Furuhashi1, Kenichi Goda2, Yuichi Shimizu3, Masayuki Kato4, Masakazu Takahashi5, Akira Dobashi1, Koji Hirata5, Ayane Oba5, Taku Shigesawa5, Masaki Inoue5, Hiroaki Matsui1, Chika Kinoshita6, Yoshitaka Ando6, Masahiro Ikegami7, Tadakazu Shimoda8, Mototsugu Kato9. 1. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan. 2. Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan. kengoendoscopy@hotmail.co.jp. 3. Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan. 4. Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan. 5. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan. 7. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan. 8. Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan. 9. National Hospital Organization Hakodate Hospital, Hakodate, Japan.
Abstract
BACKGROUND: Narrow-band imaging (NBI) classifications for Barrett's esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear. METHODS: In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett's esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6 weeks before (1st test), immediately after (2nd test), and 6 weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests. RESULTS: The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], but sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all). CONCLUSIONS: The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.
BACKGROUND: Narrow-band imaging (NBI) classifications for Barrett's esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear. METHODS: In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett's esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6 weeks before (1st test), immediately after (2nd test), and 6 weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests. RESULTS: The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], but sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all). CONCLUSIONS: The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.
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