title: The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia.
abstract: BACKGROUND
  Probe-based confocal laser endomicroscopy (pCLE) is an emerging tool for in vivo imaging of the GI tract that requires the endoscopist to interpret microscopic images. The learning curve for interpretation of pCLE images is unknown.
  
  
  OBJECTIVE
  To examine the learning curve of correctly identifying benign and neoplastic colorectal lesions by using pCLE and to evaluate the learning curve of obtaining high-quality images.
  
  
  METHODS
  Prospective, double-blind review of pCLE images of 76 colorectal lesions by using corresponding polypectomies 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 76 unknown images.
  
  
  METHODS
  Eleven endoscopists from 3 different endoscopy centers evaluated the images obtained by 1 endoscopist using the high-definition confocal probe.
  
  
  METHODS
  Patients undergoing screening and surveillance colonoscopies.
  
  
  METHODS
  Intravenous fluorescein pCLE imaging of colorectal lesions followed by polypectomies.
  
  
  METHODS
  Accuracy of image interpretation with constructing learning curve for pCLE image interpretation and acquisition.
  
  
  RESULTS
  Of the 76 colorectal lesions, 51 (67%) were neoplastic and 25 (33%) were benign, based on histopathology. Accuracy for the overall group was 63% for lesions 1 to 20, 64% for lesions 21 to 40, 79% for lesions 41 to 60, and 86% for lesions 61 to 76. The ability to obtain high-quality images was stable over the 76 cases.
  
  
  CONCLUSIONS
  Small sample size and use of offline video sequences.
  
  
  CONCLUSIONS
  Accurate interpretation of pCLE images for predicting neoplastic lesions can be learned rapidly by a wide range of GI specialists. Furthermore, the ability to acquire high-quality pCLE images is also quickly learned.
authors.affiliation: Division of Gastroenterology Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Buchner
authors.forename: Victoria
authors.initials: V
authors.lastname: Gomez
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Muhammad W
authors.initials: MW
authors.lastname: Shahid
authors.forename: Sami
authors.initials: S
authors.lastname: Achem
authors.forename: Kanwar R
authors.initials: KR
authors.lastname: Gill
authors.forename: Laith H
authors.initials: LH
authors.lastname: Jamil
authors.forename: Jamil
authors.initials: J
authors.lastname: Laith
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Simon K
authors.initials: SK
authors.lastname: Lo
authors.forename: Michael
authors.initials: M
authors.lastname: Picco
authors.forename: Douglas
authors.initials: D
authors.lastname: Riegert-Johnson
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: Daniela
authors.initials: D
authors.lastname: Sciemeca
authors.forename: Herbert
authors.initials: H
authors.lastname: Wolfsen
authors.forename: Timothy
authors.initials: T
authors.lastname: Woodward
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000236:Adenoma / Q000473:pathology; D002983:Clinical Competence; D003111:Colonic Polyps / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D018613:Microscopy, Confocal / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results