Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy.
Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy.
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DOI：
10.1016/j.gie.2010.01.053
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发表时间：
2010-07
影响因子：
7.7
通讯作者：
Meining, Alexander
中科院分区：
文献类型：
--
作者：
Wallace, Michael B.;Sharma, Prateek;Lightdale, Charles;Wolfsen, Herbert;Coron, Emmanuel;Buchner, Anna;Bajbouj, Monther;Bansal, Ajay;Rastogi, Amit;Abrams, Julian;Crook, Julia E.;Meining, Alexander
共聚焦激光显微内镜（CLE）是一种快速新兴的胃肠道体内成像方法。确定Barrett食管（BE）中基于探针的CLE（pCLE）的初步评价准确性和观察者间一致性。通过使用匹配活检作为参考标准，对40个BE组织部位的pCLE图像进行前瞻性、双盲审查。首先审查了具有已知组织学的20张图像的训练集，以标准化图像解释，然后对20张未知图像进行盲法审查。来自美国和欧洲4个不同内窥镜中心的11位BE成像专家对图像进行了评价。本研究涉及接受BE监测或评价高级别上皮内瘤变或早期腺癌的非连续患者。BE段内每个部位的静脉荧光素pCLE成像，随后进行匹配活检。pCLE诊断高级别上皮内瘤变或癌的敏感性、特异性和一致性。在验证集（n = 20），11例有高度上皮内瘤变或浸润性癌。11名内镜医师诊断肿瘤的灵敏度为88%（范围：6/11至11/11），特异性为96%（范围：7/9至9/9）。pCLE诊断基本一致（86%，kappa 0.72; 95%置信区间，0.58-0.86）。具有pCLE经验的内镜医师的总体灵敏度为91%（所有10/11），特异性为100%（所有9/9），几乎完全一致（92%，kappa 0.83; 95%置信区间，0.64-1.0）。样本量小，使用离线视频序列。结果表明，pCLE诊断BE肿瘤具有很高的准确性和可靠性。
Confocal laser endomicroscopy (CLE) is a rapidly emerging method for in vivo imaging of the GI tract. To determine the preliminary evaluation accuracy and interobserver agreement of probe-based CLE (pCLE) in Barrett’s esophagus (BE). Prospective, double-blind review of pCLE images of 40 sites of BE tissue by using matching biopsies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 20 unknown images. Eleven experts in BE imaging from 4 different endoscopy centers from the United States and Europe evaluated the images. This study involved nonconsecutive patients undergoing BE surveillance or evaluation of high-grade intraepithelial neoplasia or early adenocarcinoma. Intravenous fluorescein pCLE imaging of each site within the BE segment, followed by matching biopsy. Sensitivity, specificity, and agreement for the pCLE diagnosis of high-grade intraepithelial neoplasia or carcinoma. In the validation set (n = 20), 11 cases had high-grade intraepithelial neoplasia or invasive carcinoma. The sensitivity for the diagnosis of neoplasia for the 11 endoscopists was 88% (range 6 of 11 to 11 of 11), and the specificity was 96% (range 7 of 9 to 9 of 9). There was substantial agreement on the pCLE diagnosis (86%, kappa 0.72; 95% confidence interval, 0.58–0.86). Endomicroscopists with prior pCLE experience had an overall sensitivity of 91% (all 10 of 11), specificity of 100% (all 9 of 9), and almost perfect agreement (92%, kappa 0.83; 95% confidence interval, 0.64–1.0). Small sample size and use of offline video sequences. Results suggest that pCLE for the diagnosis of neoplasia in BE has very high accuracy and reliability.
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影响因子：
29.4
作者：
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通讯作者：
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影响因子：
3.7
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Cameron, AJ
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作者：
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作者：
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Bergman, Jacques J. G. H. M.
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24.5
作者：
Schlemper, RJ;Riddell, RH;Yamabe, H
通讯作者：
Yamabe, H