Singh R, Anagnostopoulos G K, Yao K, Karageorgiou H, Fortun P J, Shonde A, Garsed K, Kaye P V, Hawkey C J, Ragunath K
Wolfson Digestive Diseases Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Endoscopy. 2008 Jun;40(6):457-63. doi: 10.1055/s-2007-995741. Epub 2008 May 6.
Validation of a simplified classification of mucosal morphology in prediction of histology in Barrett's esophagus using narrow-band imaging with magnification (NBI-Z) and assessing its reproducibility by endoscopists experienced in the use of NBI (NBI-experts) and by endoscopists who were new to NBI (non-NBI-experts).
In a prospective cohort study of 109 patients with Barrett's esophagus at a single tertiary referral center, mucosal patterns visualized in Barrett's esophagus on NBI-Z were classified into four easily distinguishable types: A, round pits with regular microvasculature; B, villous/ridge pits with regular microvasculature; C, absent pits with regular microvasculature; D, distorted pits with irregular microvasculature. The NBI-Z grading was compared with the final histopathological diagnosis, and positive (PPV) and negative predictive values (NPV) were calculated. The reproducibility of the grading was then assessed by NBI-expert and non-NBI-expert endoscopists, and interobserver and intraobserver agreement were calculated using kappa statistics.
Per-biopsy analysis: In 903 out of 1021 distinct areas (87.9%) the NBI-Z grading corresponded to the histological diagnosis. Per-patient analysis: The PPV and NPV for type A pattern (columnar mucosa without intestinal metaplasia) were 100% and 97% respectively; for types B and C (intestinal metaplasia) they were 88% and 91% respectively, and for type D (high-grade dysplasia) 81% and 99% respectively. Inter- and intraobserver agreement: The mean kappa values in assessing the various patterns were 0.71 and 0.87 in the non-expert group; 0.78 and 0.91 in the expert group.
This study has validated a simplified classification of the various morphologic patterns visualized in Barrett's esophagus and confirmed its reproducibility when used by NBI-expert and non-NBI-expert endoscopists.
利用放大窄带成像（NBI-Z）验证巴雷特食管黏膜形态的简化分类对组织学预测的价值，并评估经验丰富的NBI内镜医师（NBI专家）和NBI新手内镜医师（非NBI专家）对其分类的可重复性。
在一家三级转诊中心对109例巴雷特食管患者进行的前瞻性队列研究中，将NBI-Z观察到的巴雷特食管黏膜模式分为四种易于区分的类型：A，具有规则微血管的圆形凹坑；B，具有规则微血管的绒毛状/嵴状凹坑；C，具有规则微血管的无凹坑；D，具有不规则微血管的扭曲凹坑。将NBI-Z分级与最终组织病理学诊断进行比较，并计算阳性预测值（PPV）和阴性预测值（NPV）。然后由NBI专家和非NBI专家内镜医师评估分级的可重复性，并使用kappa统计量计算观察者间和观察者内的一致性。
活检分析：在1021个不同区域中的903个（87.9%），NBI-Z分级与组织学诊断相符。患者分析：A类模式（无肠化生的柱状黏膜）的PPV和NPV分别为100%和97%；B类和C类（肠化生）分别为88%和91%，D类（高级别异型增生）分别为81%和99%。观察者间和观察者内一致性：非专家组评估各种模式时的平均kappa值分别为0.71和0.87；专家组为0.78和0.91。
本研究验证了巴雷特食管中观察到的各种形态模式的简化分类，并证实了NBI专家和非NBI专家内镜医师使用该分类时的可重复性。
