title: Assessment of the diagnostic performance and interobserver variability of endocytoscopy in Barrett's esophagus: a pilot ex-vivo study.
abstract: OBJECTIVE
  To investigate a classification of endocytoscopy (ECS) images in Barrett's esophagus (BE) and evaluate its diagnostic performance and interobserver variability.
  
  
  METHODS
  ECS was applied to surveillance endoscopic mucosal resection (EMR) specimens of BE ex-vivo. The mucosal surface of specimen was stained with 1% methylene blue and surveyed with a catheter-type endocytoscope. We selected still images that were most representative of the endoscopically suspect lesion and matched with the final histopathological diagnosis to accomplish accurate correlation. The diagnostic performance and inter-observer variability of the new classification scheme were assessed in a blinded fashion by physicians with expertise in both BE and ECS and inexperienced physicians with no prior exposure to ECS.
  
  
  RESULTS
  Three staff physicians and 22 gastroenterology fellows classified eight randomly assigned unknown still ECS pictures (two images per each classification) into one of four histopathologic categories as follows: (1) BEC1-squamous epithelium; (2) BEC2-BE without dysplasia; (3) BEC3-BE with dysplasia; and (4) BEC4-esophageal adenocarcinoma (EAC) in BE. Accuracy of diagnosis in staff physicians and clinical fellows were, respectively, 100% and 99.4% for BEC1, 95.8% and 83.0% for BEC2, 91.7% and 83.0% for BEC3, and 95.8% and 98.3% for BEC4. Interobserver agreement of the faculty physicians and fellows in classifying each category were 0.932 and 0.897, respectively.
  
  
  CONCLUSIONS
  This is the first study to investigate classification system of ECS in BE. This ex-vivo pilot study demonstrated acceptable diagnostic accuracy and excellent interobserver agreement.
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tomizawa
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wongkeesong
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Navtej S
authors.initials: NS
authors.lastname: Buttar
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Lori S
authors.initials: LS
authors.lastname: Lutzke
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
authors.affiliation: Yutaka Tomizawa, Prasad G Iyer, Louis M Wongkeesong, Navtej S Buttar, Lori S Lutzke, Kenneth K Wang, Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology* / Q000601:surgery; D002983:Clinical Competence; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D009092:Mucous Membrane / Q000473:pathology; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013194:Staining and Labeling; D014741:Video Recording
keywords: Barrett’s esophagus; Dysplasia; Endocytoscopy; Esophageal adenocarcinoma; Interobserver agreement