Comparison of high-resolution magnification narrow-band imaging and white-light endoscopy in the prediction of histology in Barrett's oesophagus.
OBJECTIVE
To evaluate whether there is any appreciable difference in imaging characteristics between high-resolution magnification white-light endoscopy (WLE-Z) and narrow-band imaging (NBI-Z) in Barrett's oesophagus (BE) and if this translates into superior prediction of histology.


METHODS
This was a prospective single-centre study involving 21 patients (75 areas, corresponding NBI-Z and WLE-Z images) with BE. Mucosal patterns (pit pattern and microvascular morphology) were evaluated for their image quality on a visual analogue scale (VAS) of 1-10 by five expert endoscopists. The endoscopists then predicted mucosal morphology based on four subtypes which can be visualized in BE. Type A: round pits, regular microvasculature; type B: villous/ridge pits, regular microvasculature; type C: absent pits, regular microvasculature; type D: distorted pits, irregular microvasculature. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) were then compared with the final histopathological analysis and the interobserver variability calculated.


RESULTS
The overall pit and microvasculature quality was significantly higher for NBI-Z, pit: NBI-Z=6, WLE-Z=4.5, p < 0.001; microvasculature: NBI-Z=7.3, WLE-Z=4.9, p < 0.001. This translated into a superior prediction of histology (Sn: NBI-Z: 88.9, WLE-Z: 71.9, p < 0.001). For the prediction of dysplasia, NBI-Z was superior to WLE-Z (chi(2)=10.3, p < 0.05). The overall kappa agreement among the five endoscopists for NBI-Z and WLE-Z, respectively, was 0.59 and 0.31 (p < 0.001).


CONCLUSIONS
NBI-Z is superior to WLE-Z in the prediction of histology in BE, with good reproducibility. This novel imaging modality could be an important tool for surveillance of patients with BE.
Singh
Rajvinder
R
Wolfson Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. rajvinder.singh@health.sa.gov.au
Karageorgiou
Haris
H
Owen
Victoria
V
Garsed
Klara
K
Fortun
Paul J
PJ
Fogden
Edward
E
Subramaniam
Venkataraman
V
Shonde
Anthony
A
Kaye
Philip
P
Hawkey
Christopher J
CJ
Ragunath
Krish
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000098:blood supply / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted; D008027:Light; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity