MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
Digestive Endoscopy Unit, Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy.
Clin Transl Gastroenterol. 2019 Apr;10(4):e00014. doi: 10.14309/ctg.0000000000000014.
Low-grade dysplasia (LGD) in Barrett's esophagus (BE) is generally inconspicuous on conventional and magnified endoscopy. Probe-based confocal laser endomicroscopy (pCLE) provides insight into gastro-intestinal mucosa at cellular resolution. We aimed to identify endomicroscopic features and develop pCLE diagnostic criteria for BE-related LGD.
This was a retrospective study on pCLE videos generated in 2 prospective studies. In phase I, 2 investigators assessed 30 videos to identify LGD endomicroscopic features, which were then validated in an independent video set (n = 25). Criteria with average accuracy >80% and interobserver agreement κ > 0.4 were taken forward. In phase II, 6 endoscopists evaluated the criteria in an independent video set (n = 57). The area under receiver operating characteristic curve was constructed to find the best cutoff. Sensitivity, specificity, interobserver, and intraobserver agreements were calculated.
In phase I, 6 out of 8 criteria achieved the agreement and accuracy thresholds (i) dark nonround glands, (ii) irregular gland shape, (iii) lack of goblet cells, (iv) sharp cutoff of darkness, (v) variable cell size, and (vi) cellular stratification. The best cutoff for LGD diagnosis was 3 out of 6 positive criteria. In phase II, the diagnostic criteria had a sensitivity and specificity for LGD of 81.9% and 74.6%, respectively, with an area under receiver operating characteristic of 0.888. The interobserver agreement was substantial (κ = 0.654), and the mean intraobserver agreement was moderate (κ = 0.590).
We have generated and validated pCLE criteria for LGD in BE. Using these criteria, pCLE diagnosis of LGD is reproducible and has a substantial interobserver agreement.
巴雷特食管（BE）中的低级别上皮内瘤变（LGD）在常规和放大内镜下通常不明显。基于探头的共聚焦激光内镜检查（pCLE）可提供细胞分辨率的胃肠道黏膜的深入了解。我们旨在确定内镜下特征，并为 BE 相关的 LGD 开发 pCLE 诊断标准。
这是对 2 项前瞻性研究中生成的 pCLE 视频进行的回顾性研究。在第 I 阶段，2 名研究人员评估了 30 个视频，以确定 LGD 的内镜下特征，然后在独立的视频集（n=25）中进行验证。平均准确性>80%且观察者间一致性κ>0.4的标准被采用。在第 II 阶段，6 名内镜医生在独立的视频集（n=57）中评估了这些标准。构建了接收者操作特征曲线下的面积，以找到最佳截止值。计算了敏感性、特异性、观察者间和观察者内的一致性。
在第 I 阶段，8 个标准中有 6 个达到了一致性和准确性阈值：（i）暗非圆形腺体；（ii）不规则的腺体形状；（iii）缺乏杯状细胞；（iv）黑暗的锐利截止；（v）可变的细胞大小；和（vi）细胞分层。LGD 诊断的最佳截止值为 6 个阳性标准中的 3 个。在第 II 阶段，这些诊断标准对 LGD 的敏感性和特异性分别为 81.9%和 74.6%，受试者工作特征曲线下的面积为 0.888。观察者间的一致性是显著的（κ=0.654），平均观察者内的一致性是中度的（κ=0.590）。
我们已经生成并验证了 BE 中 LGD 的 pCLE 标准。使用这些标准，pCLE 对 LGD 的诊断是可重复的，并且具有显著的观察者间一致性。
