title: Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings.
abstract: OBJECTIVE
  To compare the interpretation of probe-based confocal laser endomicroscopy (pCLE) findings between endoscopists and gastrointestinal (GI)-pathologists.
  
  
  METHODS
  All pCLE procedures were undertaken and the endoscopist rendered assessment. The same pCLE videos were then viewed offline by an expert GI pathologist. Histopathology was considered the gold standard for definitive diagnosis. The sensitivity, specificity and accuracy for diagnosis of dysplastic/ neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for pCLE findings were analyzed.
  
  
  RESULTS
  Of the 66 included patients, 40 (60.6%) had lesions in the esophagus, 7 (10.6%) in the stomach, 15 (22.7%) in the biliary tract, 3 (4.5%) in the ampulla and 1 (1.5%) in the colon. The overall sensitivity, specificity and accuracy for diagnosing dysplastic/neoplastic lesions using pCLE were higher for endoscopists than pathologist at 87.0% vs 69.6%, 80.0% vs 40.0% and 84.8% vs 60.6% (P = 0.0003), respectively. Area under the ROC curve (AUC) was greater for endoscopists than the pathologist (0.83 vs 0.55, P = 0.0001). Overall agreement between endoscopists and pathologist was moderate for all GI lesions (K = 0.43; 95%CI: 0.26-0.61), luminal lesions (K = 0.40; 95%CI: 0.20-0.60) and those of dysplastic/neoplastic pathology (K = 0.55; 95%CI: 0.37-0.72), the agreement was poor for benign (K = 0.13; 95%CI: -0.097-0.36) and pancreaticobiliary lesions (K = 0.19; 95%CI: -0.26-0.63).
  
  
  CONCLUSIONS
  There is a wide discrepancy in the interpretation of pCLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions. Further studies are needed to identify the cause of this poor agreement.
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Leona
authors.initials: L
authors.lastname: Council
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Helmut
authors.initials: H
authors.lastname: Neumann
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
authors.forename: Charles Melbern
authors.initials: CM
authors.lastname: Wilcox
mesh_terms: D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D018715:Microscopy, Video / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D010820:Physicians; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013038:Specialization
keywords: Confocal endomicroscopy; Gastointestinal; Interobserver variation