title: Influence of reviewers' clinical backgrounds on interpretation of confocal laser endomicroscopy findings.
abstract: OBJECTIVE
  Substantial differences in endoscopic strategy for gastric cancer exist between Western and Eastern countries, owing to clinicoepidemiological diversity, including differences in the prevalence of gastric cancer. This international multicenter study involved German and Japanese institutions and aimed to evaluate the influence of reviewers' clinical backgrounds on interpreting probe-based confocal laser endomicroscopy (pCLE) findings for diagnosis of superficial gastric lesions.
  
  
  METHODS
  39 reviewers answered questionnaires about their clinical background and then reviewed 30 sets of white light endoscopy (WLE) and pCLE video clips via an online questionnaire. For each set of clips, reviewers were asked to classify lesions as neoplastic or non-neoplastic. RESULTS of video reviews were compared with the final histopathological diagnosis for each lesion. The accuracy of diagnosis based on WLE + pCLE was compared with that based on WLE alone for each aspect of clinical background.
  
  
  RESULTS
  The overall accuracy of diagnosis based on WLE + pCLE was higher than that based on WLE alone (73.93 % vs. 65.64 %, P = .0002). Outcomes of expert gastroenterologists were better than those of pathologists (P = .038 for WLE, P = .002 for WLE + pCLE) and outcomes of reviewers at Japanese institutions were better than those of reviewers at German institutions (P = .001 for WLE, P < .001 for WLE + pCLE).
  
  
  CONCLUSIONS
  Reviewers from Japanese institutions and expert gastroenterologists performed well in the pCLE interpretation. Substantial experience in conventional endoscopy is important for interpreting pCLE images for the diagnosis of gastric cancer.University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; www.umin.ac.jp/ctr/index.htm) number UMIN 000013437).
authors: Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
authors: Masakuni
authors: M
authors: Kobayashi
authors: Department of Medicine, Interdisciplinary Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Helmut
authors: H
authors: Neumann
authors: Department of Neuropsychiatry, Ishikawa Prefectural Takamatsu Hospital, Ishikawa, Japan.
authors: Shoryoku
authors: S
authors: Hino
authors: Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany.
authors: Michael
authors: M
authors: Vieth
authors: Endoscopy Division, National Cancer Center, Tokyo, Japan.
authors: Seiichiro
authors: S
authors: Abe
authors: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors: Yousuke
authors: Y
authors: Nakai
authors: Department of Surgery, Osaka University, Osaka, Japan.
authors: Kiyokazu
authors: K
authors: Nakajima
authors: Department of Internal Medicine II, Helios HSK Hospital, Wiesbaden, Germany.
authors: Ralf
authors: R
authors: Kiesslich
authors: Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan.
authors: Shinichi
authors: S
authors: Hirooka
authors: Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
authors: Kazuki
authors: K
authors: Sumiyama
mesh_terms: D000368:Aged; D002983:Clinical Competence; D016099:Endoscopy, Gastrointestinal / Q000193:education / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology / Q000193:education / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D000069416:Intravital Microscopy; D007564:Japan; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D015588:Observer Variation; D010336:Pathology / Q000193:education / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011795:Surveys and Questionnaires; D014741:Video Recording