The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia
The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia
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DOI：
10.1016/j.gie.2011.01.002
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发表时间：
2011-03-01
影响因子：
7.7
通讯作者：
Wallace, Michael B.
中科院分区：
文献类型：
--
作者：
Buchner, Anna M.;Gomez, Victoria;Wallace, Michael B.
背景资料：基于探针的共聚焦激光显微内镜（pCLE）是一种新兴的工具，用于胃肠道的体内成像，需要内窥镜医生解释显微图像。pCLE图像解释的学习曲线是unknown.Objective：为了检查正确识别良性和肿瘤性结直肠病变的学习曲线，通过使用pCLE和评估获得高质量images.Design的学习曲线：前瞻性，双盲审查pCLE图像的76结直肠病变，使用相应的息肉切除术作为参考标准。首先对20张已知组织学图像的训练集进行审查，以标准化图像解释，然后对76张未知图像进行盲法审查。设置：来自3个不同内窥镜中心的11名内窥镜医师评估了1名内窥镜医师使用高清共聚焦探头获得的图像。患者：接受筛查和监测结肠镜检查的患者。干预：结肠直肠病变的静脉荧光素pCLE成像，随后进行息肉切除术。主要结果测量：通过构建pCLE图像解释和采集的学习曲线，图像解释的准确性。结果：在76个结直肠病变中，根据组织病理学，51个（67%）为肿瘤性病变，25个（33%）为良性病变。总体组的准确性为：病变1至20的准确性为63%，病变21至40的准确性为64%，病变41至60的准确性为79%，病变61至76的准确性为86%。获得高质量图像的能力是稳定的76 cases.Limitations：小样本量和使用离线video sequences.Conclusions：准确的解释pCLE图像预测肿瘤病变可以快速学习广泛的GI专家。此外，还可以快速学习获取高质量pCLE图像的能力。（Gastrointest Endosc 2011;73：556-60.）
Background: Probe-based confocal laser endomicroscopy (pCLE) is an emerging tool for in vivo imaging of the GI tract that requires the endoscopist to interpret microscopic images. The learning curve for interpretation of pCLE images is unknown.Objective: To examine the learning curve of correctly identifying benign and neoplastic colorectal lesions by using pCLE and to evaluate the learning curve of obtaining high-quality images.Design: Prospective, double-blind review of pCLE images of 76 colorectal lesions by using corresponding polypectomies 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 76 unknown images.Setting: Eleven encloscopists from 3 different endoscopy centers evaluated the images obtained by 1 endoscopist using the high-definition confocal probe.Patients: Patients undergoing screening and surveillance colonoscopies.Intervention: Intravenous fluorescein pCLE imaging of colorectal lesions followed by polypectomies.Main Outcome Measurements: Accuracy of image interpretation with constructing learning curve for pCLE image interpretation and acquisition.Results: Of the 76 colorectal lesions, 51 (67%) were neoplastic and 25 (33%) were benign, based on histopathology. Accuracy for the overall group was 63% for lesions 1 to 20, 64% for lesions 21 to 40, 79% for lesions 41 to 60, and 86% for lesions 61 to 76. The ability to obtain high-quality images was stable over the 76 cases.Limitations: Small sample size and use of offline video sequences.Conclusions: Accurate interpretation of pCLE images for predicting neoplastic lesions can be learned rapidly by a wide range of GI specialists. Furthermore, the ability to acquire high-quality pCLE images is also quickly learned. (Gastrointest Endosc 2011;73:556-60.)