Peter Shajan, Council Leona, Bang Ji Young, Neumann Helmut, Mönkemüller Klaus, Varadarajulu Shyam, Wilcox Charles Melbern
Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States.
World J Gastroenterol. 2014 Dec 21;20(47):17993-8000. doi: 10.3748/wjg.v20.i47.17993.
To compare the interpretation of probe-based confocal laser endomicroscopy (pCLE) findings between endoscopists and gastrointestinal (GI)-pathologists.
All pCLE procedures were undertaken and the endoscopist rendered assessment. The same pCLE videos were then viewed offline by an expert GI pathologist. Histopathology was considered the gold standard for definitive diagnosis. The sensitivity, specificity and accuracy for diagnosis of dysplastic/ neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for pCLE findings were analyzed.
Of the 66 included patients, 40 (60.6%) had lesions in the esophagus, 7 (10.6%) in the stomach, 15 (22.7%) in the biliary tract, 3 (4.5%) in the ampulla and 1 (1.5%) in the colon. The overall sensitivity, specificity and accuracy for diagnosing dysplastic/neoplastic lesions using pCLE were higher for endoscopists than pathologist at 87.0% vs 69.6%, 80.0% vs 40.0% and 84.8% vs 60.6% (P = 0.0003), respectively. Area under the ROC curve (AUC) was greater for endoscopists than the pathologist (0.83 vs 0.55, P = 0.0001). Overall agreement between endoscopists and pathologist was moderate for all GI lesions (K = 0.43; 95%CI: 0.26-0.61), luminal lesions (K = 0.40; 95%CI: 0.20-0.60) and those of dysplastic/neoplastic pathology (K = 0.55; 95%CI: 0.37-0.72), the agreement was poor for benign (K = 0.13; 95%CI: -0.097-0.36) and pancreaticobiliary lesions (K = 0.19; 95%CI: -0.26-0.63).
There is a wide discrepancy in the interpretation of pCLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions. Further studies are needed to identify the cause of this poor agreement.
比较内镜医师与胃肠病理学家对基于探头的共聚焦激光显微内镜检查（pCLE）结果的解读。
进行所有pCLE检查，由内镜医师进行评估。然后，一位胃肠病理专家离线观看相同的pCLE视频。组织病理学被视为明确诊断的金标准。分析了pCLE诊断发育异常/肿瘤性胃肠病变的敏感性、特异性和准确性，以及内镜医师与经验丰富的胃肠病理学家之间对pCLE结果的观察者间一致性。
在纳入的66例患者中，40例（60.6%）病变位于食管，7例（10.6%）位于胃，15例（22.7%）位于胆道，3例（4.5%）位于壶腹，1例（1.5%）位于结肠。内镜医师使用pCLE诊断发育异常/肿瘤性病变的总体敏感性、特异性和准确性高于病理学家，分别为87.0%对69.6%、80.0%对40.0%和84.8%对60.6%（P = 0.0003）。内镜医师的ROC曲线下面积（AUC）大于病理学家（0.83对0.55，P = 0.0001）。内镜医师与病理学家对所有胃肠病变、腔内病变以及发育异常/肿瘤性病理病变的总体一致性为中等（K = 0.43；95%CI：0.26 - 0.61），对良性病变（K = 0.13；95%CI： - 0.097 - 0.36）和胰胆病变（K = 0.19；95%CI： - 0.26 - 0.63）的一致性较差。
内镜医师与病理学家对pCLE结果的解读存在较大差异，尤其是对良性和恶性胰胆病变。需要进一步研究以确定这种一致性差的原因。
