title: Learning curve and interobserver agreement of confocal laser endomicroscopy for detecting precancerous or early-stage esophageal squamous cancer.
abstract: BACKGROUND
  Confocal laser endomicroscopy (CLE) can provide in vivo subcellular resolution images of esophageal lesions. However, the learning curve in interpreting CLE images of precancerous or early-stage esophageal squamous cancer is unknown. The goal of this study is to evaluate the diagnostic accuracy and inter-observer agreement for differentiating esophageal lesions in CLE images among experienced and inexperienced observers and to assess the learning curve.
  
  
  METHODS
  After a short training, 8 experienced and 14 inexperienced endoscopists evaluated in sequence 4 sets of high-quality CLE images. Their diagnoses were corrected and discussed after each set. For each image, the diagnostic results, confidence in diagnosis, quality and time to evaluate were recorded.
  
  
  RESULTS
  Overall, diagnostic accuracy was greater for the second, third, fourth set of images as compared with the initial set (odds ratio [OR] 2.01, 95% CI 1.22-3.31; 7.95, 3.74-16.87; and 6.45, 3.14-13.27), respectively, with no difference between the third and fourth sets in accuracy (p = 0.67). Previous experience affected the diagnostic accuracy only in the first set of images (OR 3.70, 1.87-7.29, p<0.001). Inter-observer agreement was higher for experienced than inexperienced endoscopists (0.732 vs. 0.666, p<0.01).
  
  
  CONCLUSIONS
  CLE is a promising technology that can be quickly learned after a short training period; previous experience is associated with diagnostic accuracy only at the initial stage of learning.
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China; Department of Anesthesiology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Xiu-Li
authors.initials: XL
authors.lastname: Zuo
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Dong
authors.affiliation: Department of Pathology, the Second Affiliated Hospital, Shandong University, Jinan, China.
authors.forename: Cheng-Jun
authors.initials: CJ
authors.lastname: Zhou
authors.affiliation: Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Li
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D007834:Lasers; D059032:Learning Curve; D018613:Microscopy, Confocal / Q000379:methods*; D015588:Observer Variation; D011230:Precancerous Conditions / Q000473:pathology*; D011379:Prognosis