title: Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy.
abstract: BACKGROUND
  Confocal laser endomicroscopy (CLE) is a rapidly emerging method for in vivo imaging of the GI tract.
  
  
  OBJECTIVE
  To determine the preliminary evaluation accuracy and interobserver agreement of probe-based CLE (pCLE) in Barrett's esophagus (BE).
  
  
  METHODS
  Prospective, double-blind review of pCLE images of 40 sites of BE tissue by using matching biopsies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 20 unknown images.
  
  
  METHODS
  Eleven experts in BE imaging from 4 different endoscopy centers from the United States and Europe evaluated the images.
  
  
  METHODS
  This study involved nonconsecutive patients undergoing BE surveillance or evaluation of high-grade intraepithelial neoplasia or early adenocarcinoma.
  
  
  METHODS
  Intravenous fluorescein pCLE imaging of each site within the BE segment, followed by matching biopsy.
  
  
  METHODS
  Sensitivity, specificity, and agreement for the pCLE diagnosis of high-grade intraepithelial neoplasia or carcinoma.
  
  
  RESULTS
  In the validation set (n = 20), 11 cases had high-grade intraepithelial neoplasia or invasive carcinoma. The sensitivity for the diagnosis of neoplasia for the 11 endoscopists was 88% (range 6 of 11 to 11 of 11), and the specificity was 96% (range 7 of 9 to 9 of 9). There was substantial agreement on the pCLE diagnosis (86%, kappa 0.72; 95% confidence interval, 0.58-0.86). Endomicroscopists with prior pCLE experience had an overall sensitivity of 91% (all 10 of 11), specificity of 100% (all 9 of 9), and almost perfect agreement (92%, kappa 0.83; 95% confidence interval, 0.64-1.0).
  
  
  CONCLUSIONS
  Small sample size and use of offline video sequences.
  
  
  CONCLUSIONS
  Results suggest that pCLE for the diagnosis of neoplasia in BE has very high accuracy and reliability.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Charles
authors.initials: C
authors.lastname: Lightdale
authors.forename: Herbert
authors.initials: H
authors.lastname: Wolfsen
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.forename: Anna
authors.initials: A
authors.lastname: Buchner
authors.forename: Monther
authors.initials: M
authors.lastname: Bajbouj
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Julian
authors.initials: J
authors.lastname: Abrams
authors.forename: Julia E
authors.initials: JE
authors.lastname: Crook
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000295:instrumentation; D002278:Carcinoma in Situ / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002983:Clinical Competence / Q000706:statistics & numerical data; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000473:pathology*; D020701:Esophagoscopes / Q000706:statistics & numerical data*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D014741:Video Recording / Q000295:instrumentation
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