title: Accuracy and interrater reliability for the diagnosis of Barrett's neoplasia among users of a novel, portable high-resolution microendoscope.
abstract: The high-resolution microendoscope (HRME) is a novel imaging modality that may be useful in the surveillance of Barrett's esophagus in low-resource or community-based settings. In order to assess accuracy and interrater reliability of microendoscopists in identifying Barrett's-associated neoplasia using HRME images, we recruited 20 gastroenterologists with no microendoscopic experience and three expert microendoscopists in a large academic hospital in New York City to interpret HRME images. They prospectively reviewed 40 HRME images from 28 consecutive patients undergoing surveillance for metaplasia and low-grade dysplasia and/or evaluation for high-grade dysplasia or cancer. Images were reviewed in a blinded fashion, after a 4-minute training with 11 representative images. All imaged sites were biopsied and interpreted by an expert pathologist. Sensitivity of all endoscopists for identification of high-grade dysplasia or cancer was 0.90 (95% confidence interval [CI]: 0.88-0.92) and specificity was 0.82 (95% CI: 0.79-0.85). Positive and negative predictive values were 0.72 (95% CI: 0.68-0.77) and 0.94 (95% CI: 0.92-0.96), respectively. No significant differences in accuracy were observed between experts and novices (0.90 vs. 0.84). The kappa statistic for all raters was 0.56 (95% CI: 0.54-0.58), and the difference between groups was not significant (0.64 vs. 0.55). These data suggest that gastroenterologists can diagnose Barrett's-related neoplasia on HRME images with high sensitivity and specificity, without the aid of prior microendoscopy experience.
authors: Mount Sinai School of Medicine, New York, New York, USA.
authors: P M
authors: PM
authors: Vila
authors: M J
authors: MJ
authors: Kingsley
authors: A D
authors: AD
authors: Polydorides
authors: M-A
authors: MA
authors: Protano
authors: M C
authors: MC
authors: Pierce
authors: J
authors: J
authors: Sauk
authors: M K
authors: MK
authors: Kim
authors: K
authors: K
authors: Patel
authors: J H
authors: JH
authors: Godbold
authors: J D
authors: JD
authors: Waye
authors: R
authors: R
authors: Richards-Kortum
authors: S
authors: S
authors: Anandasabapathy
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology*
keywords: cancer; diagnostic imaging; esophagogastroduodenoscopy; optical device