Curvers W L, Bohmer C J, Mallant-Hent R C, Naber A H, Ponsioen C I, Ragunath K, Singh R, Wallace M B, Wolfsen H C, Song L-M Wong Kee, Lindeboom R, Fockens P, Bergman J J
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
Endoscopy. 2008 Oct;40(10):799-805. doi: 10.1055/s-2008-1077596. Epub 2008 Sep 30.
We have recently proposed a classification of mucosal morphology in Barrett's esophagus based on three criteria: regularity of mucosal pattern, regularity of vascular pattern, and presence of abnormal blood vessels. We aimed to evaluate the interobserver agreement with the proposed mucosal morphology classification and to assess the additional value of narrow band imaging (NBI) over high resolution white light endoscopy (HR-WLE).
Five international experts in the field of Barrett's imaging and seven community endoscopists with no expertise in this field independently evaluated magnified still images from 50 areas, obtained with HR-WLE and NBI, in Barrett's esophagus patients. Visual analogue scales (VAS) were used for scoring imaging quality. Interobserver agreement for mucosal morphology and yield for identifying early neoplasia were assessed.
Imaging qualities of NBI were rated more highly than HR-WLE, when evaluated separately as well as in a side-by-side comparison. The interobserver agreement ranged from 0.40 to 0.56 and did not significantly differ between expert and non-expert endoscopists. The overall yield for correctly identifying images of early neoplasia was 81 % for HR-WLE, 72 % for NBI and 83 % for HR-WLE + NBI, with no significant difference between experts and non-experts.
Interobserver agreement for the classification of mucosal morphology was moderate. Although NBI was rated more highly than HR-WLE for imaging quality, this did not result in improved interobserver agreement or increased yield for identifying early neoplasia in Barrett's esophagus. This applied to non-expert as well as expert endoscopists.
我们最近基于三个标准提出了巴雷特食管黏膜形态的分类方法：黏膜形态的规则性、血管形态的规则性以及异常血管的存在情况。我们旨在评估观察者间对所提出的黏膜形态分类的一致性，并评估窄带成像（NBI）相对于高分辨率白光内镜检查（HR-WLE）的附加价值。
巴雷特成像领域的五名国际专家和七名对此领域无专业经验的社区内镜医师独立评估了巴雷特食管患者通过HR-WLE和NBI获得的50个区域的放大静态图像。使用视觉模拟量表（VAS）对成像质量进行评分。评估观察者间在黏膜形态方面的一致性以及识别早期肿瘤的检出率。
单独评估以及并排比较时，NBI的成像质量评分均高于HR-WLE。观察者间的一致性范围为0.40至0.56，专家内镜医师和非专家内镜医师之间无显著差异。HR-WLE正确识别早期肿瘤图像的总体检出率为81%，NBI为72%，HR-WLE + NBI为83%，专家和非专家之间无显著差异。
观察者间对黏膜形态分类的一致性为中等。尽管NBI的成像质量评分高于HR-WLE，但这并未导致观察者间一致性的提高或巴雷特食管早期肿瘤识别检出率的增加。这适用于非专家内镜医师以及专家内镜医师。
