title: Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images.
abstract: BACKGROUND
  Confocal laser endomicroscopy (CLE) may be used to diagnose gastric cancer and intestinal metaplasia, but the impact of CLE experience on the accuracy of confocal diagnosis of gastric cancer and intestinal metaplasia is not clear.
  
  
  OBJECTIVE
  To establish the sensitivity, specificity, and intragroup interobserver agreement of CLE image interpretation by 3 experienced (group 1) and 3 inexperienced (group 2) CLE endoscopists for diagnosing gastric intestinal metaplasia (GIM) and adenocarcinoma.
  
  
  METHODS
  Blinded review of CLE images for the diagnosis of gastric cancer or intestinal metaplasia.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  CLE images obtained ex vivo from gastrectomy specimens with proven gastric cancer and CLE images obtained in vivo from Chinese subjects older than 50 years of age by using matched biopsy specimens as reference standards.
  
  
  METHODS
  Sensitivity, specificity, and intragroup interobserver agreement of CLE image interpretation.
  
  
  RESULTS
  Interpretation of in vivo images by group 1 was associated with higher sensitivity (95.2% vs 61.9%, P = .039) and higher specificity (93.3% vs 62.2%, P < .001) for GIM than interpretation by group 2. The agreement between interpretation by group 1 and histology for GIM was higher than that for group 2 (κ = 0.864 vs 0.217). The sensitivity (93.3% for group 1 vs 86.7% for group 2, P = 1.000) and specificity (87.7% for group 1 vs 80.7% for group 2, P = .344) of interpretation of ex vivo CLE images for the diagnosis of gastric adenocarcinoma was similar for groups 1 and 2.
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  Experience in CLE was associated with greater accuracy in the diagnosis of intestinal metaplasia.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Health System, Singapore.
authors.forename: Lee Guan
authors.initials: LG
authors.lastname: Lim
authors.forename: Khay Guan
authors.initials: KG
authors.lastname: Yeoh
authors.forename: Manuel
authors.initials: M
authors.lastname: Salto-Tellez
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Khor
authors.forename: Ming
authors.initials: M
authors.lastname: Teh
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Jimmy B Y
authors.initials: JB
authors.lastname: So
authors.forename: Andrea
authors.initials: A
authors.lastname: Rajnakova
authors.forename: Emily
authors.initials: E
authors.lastname: Shen
authors.forename: Supriya
authors.initials: S
authors.lastname: Srivastava
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D002983:Clinical Competence; D016099:Endoscopy, Gastrointestinal; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008679:Metaplasia / Q000473:pathology; D018613:Microscopy, Confocal; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology*