title: Volumetric laser endomicroscopy in Barrett's esophagus: interobserver agreement for interpretation of Barrett's esophagus and associated neoplasia among high-frequency users.
abstract: OBJECTIVE
  Targeting neoplasia in Barrett's esophagus (BE) is challenging. Volumetric laser endomicroscopy (VLE) is a new imaging technique that allows for real time cross-sectional microstructure imaging that can detect BE neoplasia. The interobserver agreement among users in practice is unknown.
  
  
  METHODS
  Eight high-volume users of VLE from different academic centers in the United States evaluated 120 stored VLE images blinded to the endoscopic and clinical findings. There were 30 images for each tissue type: gastric cardia, esophageal squamous mucosa, nonneoplastic BE, and neoplastic BE. Each image with BE had corresponding histology confirming the tissue diagnosis. Each normal esophagus and gastric cardia had matching endoscopic images confirming normal mucosa. These were considered the criterion standard. Respondents were asked to classify the images into 1 of each category. Agreement among the users was measured.
  
  
  RESULTS
  The overall agreement among users was almost perfect (kappa = 0.81; 95% confidence interval [CI], 0.79-0.83). For esophageal squamous and gastric cardia, the agreement was almost perfect (kappa 0.95 and 0.86, respectively [95% CI, 0.92-0.98 and 0.83-0.89]). For nonneoplastic BE and neoplastic BE, the agreement was strong (kappa 0.66 [95% CI, 0.63-0.69] and 0.79 [95% CI, 0.75-0.82], respectively). When compared with the criterion standard, the median accuracy for identifying normal squamous mucosa, normal gastric mucosa, nonneoplastic BE, neoplastic BE, and all tissue types was 99% (95% CI, 98%-100%), 97% (95% CI, 95%-99%), 93% (95% CI, 88%-98%), 95% (95% CI, 91%-99%), and 96% (95% CI, 94%-99%), respectively.
  
  
  CONCLUSIONS
  VLE has a high level of agreement and accuracy among high-volume users.
authors.affiliation: Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Arvind J
authors.initials: AJ
authors.lastname: Trindade
authors.affiliation: Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Sumant
authors.initials: S
authors.lastname: Inamdar
authors.affiliation: Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Smith
authors.affiliation: H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Cadman L
authors.initials: CL
authors.lastname: Leggett
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lightdale
authors.affiliation: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Pleskow
authors.affiliation: Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Divyesh V
authors.initials: DV
authors.lastname: Sejpal
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard-MIT Division of Health Sciences Technology, Cambridge, USA.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Tearney
authors.affiliation: Hofstra Northwell School of Medicine, Northwell Health System, Department of Pathology, New Hyde Park, New York, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Thomas
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology; D002299:Cardia / Q000000981:diagnostic imaging / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D000071041:Esophageal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D000069416:Intravital Microscopy / Q000379:methods*; D018613:Microscopy, Confocal; D015588:Observer Variation; D012372:ROC Curve