Gastroenterology and Liver Services, Bankstown Hospital, Sydney South West Local Health District, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia; Faculty of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia.
Gastrointest Endosc. 2016 Apr;83(4):785-91.e1. doi: 10.1016/j.gie.2015.08.045. Epub 2015 Sep 3.
Confocal laser endomicroscopy can dynamically assess intestinal mucosal barrier defects and increased intestinal permeability (IP). These are functional features that do not have corresponding appearance on histopathology. As such, previous pathology training may not be beneficial in learning these dynamic features. This study aims to evaluate the diagnostic accuracy, learning curve, inter- and intraobserver agreement for identifying features of increased IP in experienced and inexperienced analysts and pathologists.
A total of 180 endoscopic confocal laser endomicroscopy (Pentax EC-3870FK; Pentax, Tokyo, Japan) images of the terminal ileum, subdivided into 6 sets of 30 were evaluated by 6 experienced analysts, 13 inexperienced analysts, and 2 pathologists, after a 30-minute teaching session. Cell-junction enhancement, fluorescein leak, and cell dropout were used to represent increased IP and were either present or absent in each image. For each image, the diagnostic accuracy, confidence, and quality were assessed.
Diagnostic accuracy was significantly higher for experienced analysts compared with inexperienced analysts from the first set (96.7% vs 83.1%, P < .001) to the third set (95% vs 89.7, P = .127). No differences in accuracy were noted between inexperienced analysts and pathologists. Confidence (odds ratio, 8.71; 95% confidence interval, 5.58-13.57) and good image quality (odds ratio, 1.58; 95% confidence interval, 1.22-2.03) were associated with improved interpretation. Interobserver agreement κ values were high and improved with experience (experienced analysts, 0.83; inexperienced analysts, 0.73; and pathologists, 0.62). Intraobserver agreement was >0.86 for experienced observers.
Features representative of increased IP can be rapidly learned with high inter- and intraobserver agreement. Confidence and image quality were significant predictors of accurate interpretation. Previous pathology training did not have an effect on learning.
共聚焦激光内镜检查可动态评估肠黏膜屏障缺陷和肠通透性增加（IP）。这些是没有相应组织病理学表现的功能特征。因此，之前的病理学培训可能对学习这些动态特征没有帮助。本研究旨在评估有经验和无经验的分析员和病理学家识别 IP 增加特征的诊断准确性、学习曲线、观察者间和观察者内一致性。
180 例末端回肠内镜共聚焦激光检查（Pentax EC-3870FK；Pentax，东京，日本）图像分为 6 组，每组 30 张，由 6 名有经验的分析员、13 名无经验的分析员和 2 名病理学家在 30 分钟的教学课程后进行评估。细胞连接增强、荧光素渗漏和细胞脱落用于代表 IP 增加，并且在每张图像中均存在或不存在。对于每张图像，评估诊断准确性、信心和质量。
与无经验的分析员相比，有经验的分析员从第一组（96.7%比 83.1%，P<0.001）到第三组（95%比 89.7%，P=0.127）的诊断准确性显著提高。无经验的分析员和病理学家之间的准确性无差异。信心（比值比，8.71；95%置信区间，5.58-13.57）和良好的图像质量（比值比，1.58；95%置信区间，1.22-2.03）与解释的改善相关。观察者间一致性κ 值较高，且随经验而提高（有经验的分析员，0.83；无经验的分析员，0.73；和病理学家，0.62）。有经验的观察者的观察者内一致性>0.86。
具有代表性的 IP 增加特征可快速学习，具有较高的观察者间和观察者内一致性。信心和图像质量是准确解释的重要预测因素。之前的病理学培训对学习没有影响。
