Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan.
J Gastroenterol. 2019 Jul;54(7):587-596. doi: 10.1007/s00535-018-01537-7. Epub 2019 Jan 2.
Narrow-band imaging (NBI) classifications for Barrett's esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear.
In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett's esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6 weeks before (1st test), immediately after (2nd test), and 6 weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests.
The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], but sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all).
The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.
窄带成像（NBI）分类法已被提议用于 Barrett 食管的早期食管癌检测。我们开发了一种简化的分类系统，该系统在经验丰富的内镜医生中具有较高的诊断准确性和可重复性，但在新手内镜医生中的可行性尚不清楚。
在本研究中，8 名没有使用高倍放大内镜进行放大内镜检查经验的新手内镜医生被要求在接受简化分类系统培训前（第 1 次测试）、培训后即刻（第 2 次测试）和 6 周后（第 3 次测试），共 248 张 Barrett 食管图像（72 张异型增生，176 张非异型增生），这些图像是通过高清放大 NBI 获得的。主要结局指标为三次测试中对异型增生的诊断准确性差异。
第 2 次测试的特异性和总准确性明显高于第 1 次测试[97%比 80%（p<0.001）和 94%比 82%（p<0.001）]，但敏感性相似（两次测试均为 87%；p=0.42）。在第 3 次测试中，与第 2 次测试相比，敏感性和总准确性明显降低[82%比 87%（p<0.001）和 93%比 94%（p<0.05）]，但特异性无显著差异（两次测试均为 97%；p=0.16）。黏膜模式、血管模式和预测组织学的观察者间一致性kappa 值较高，且在第 2 次测试中明显高于第 1 次测试（0.78 比 0.59、0.70 比 0.53 和 0.79 比 0.66，均 p<0.001）。
简化的 NBI 分类系统可能适合新手内镜医生使用，以提供高准确性和可重复性。
