title: Development and Validation of a Classification System to Identify High-Grade Dysplasia and Esophageal Adenocarcinoma in Barrett's Esophagus Using Narrow-Band Imaging.
abstract: OBJECTIVE
  Although several classification systems have been proposed for characterization of Barrett's esophagus (BE) surface patterns based on narrow-band imaging (NBI), none have been widely accepted. The Barrett's International NBI Group (BING) aimed to develop and validate an NBI classification system for identification of dysplasia and cancer in patients with BE.
  
  
  METHODS
  The BING working group, composed of NBI experts from the United States, Europe, and Japan, met to develop a validated, consensus-driven NBI classification system for identifying dysplasia and cancer in BE. The group reviewed 60 NBI images of nondysplastic BE, high-grade dysplasia, and esophageal adenocarcinoma to characterize mucosal and vascular patterns visible by NBI; these features were used to develop the BING criteria. We then recruited adult patients undergoing surveillance or endoscopic treatment for BE at 4 institutions in the United States and Europe, obtaining high-quality NBI images and performing histologic analysis of biopsies. Experts individually reviewed 50 NBI images to validate the BING criteria, and then evaluated 120 additional NBI images (not previously viewed) to determine whether the criteria accurately predicted the histology results.
  
  
  RESULTS
  The BING criteria identified patients with dysplasia with 85% overall accuracy, 80% sensitivity, 88% specificity, 81% positive predictive value, and 88% negative predictive value. When dysplasia was identified with a high level of confidence, these values were 92%, 91%, 93%, 89%, and 95%, respectively. The overall strength of inter-observer agreement was substantial (κ = 0.681).
  
  
  CONCLUSIONS
  The BING working group developed a simple, internally validated system to identify dysplasia and EAC in patients with BE based on NBI results. When images are assessed with a high degree of confidence, the system can classify BE with >90% accuracy and a high level of inter-observer agreement.
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri. Electronic address: psharma@kumc.edu.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Internal Medicine, Clinic Augsburg, Augsburg, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Messmann
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Alsop
authors.affiliation: Department of Gastroenterology, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vennalaganti
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, Chicago, Illinois.
authors.forename: Vani
authors.initials: V
authors.lastname: Konda
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, Chicago, Illinois.
authors.forename: Ann
authors.initials: A
authors.lastname: Koons
authors.affiliation: Department of Internal Medicine, Clinic Augsburg, Augsburg, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Penner
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, Chicago, Illinois.
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000145:classification / Q000473:pathology*; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D001808:Blood Vessels / Q000473:pathology; D032921:Consensus; D004938:Esophageal Neoplasms / Q000098:blood supply / Q000145:classification / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000098:blood supply / Q000473:pathology*; D005060:Europe; D006801:Humans; D007564:Japan; D009092:Mucous Membrane / Q000473:pathology; D062048:Narrow Band Imaging; D060787:Neoplasm Grading; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014481:United States
keywords: Endoscopy; Esophageal Cancer; NDBE; Risk Factors