Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan,
Digestion. 2020;101(5):590-597. doi: 10.1159/000501479. Epub 2019 Jul 16.
Magnified endoscopy is difficult for novice endoscopists because it requires both knowledge and skill of endoscopic diagnosis. The aim of this study was to examine the diagnostic performance of novice endoscopists on determining the invasive depth of colorectal neoplasms and compare it with that of experts.
The present study was conducted as a post hoc analysis. Thirty expert and 30 novice endoscopists who use magnifying endoscopy (narrow-band imaging [NBI] and pit pattern analysis) were recruited for the online survey. Novice endoscopist was defined as one who has <5 years of experience in magnifying endoscopy. Three outcomes were assessed: (a) diagnostic accuracy of both novice and expert endoscopists in determining the depth of invasion; (b) additional diagnostic accuracy of novice endoscopists in determining the depth of invasion with magnifying NBI or pit pattern compared with nonmagnifying white light imaging (WLI); (c) difference in confidence on diagnosis among each modality between novice and expert endoscopists.
The area under the curve (AUC) of expert endoscopists was significantly higher than that of novice endoscopists. The AUC of the pit pattern was significantly higher than that of WLI regardless of lesion characteristics as determined by novice endoscopists. The proportion of answers with high confidence was significantly higher with expert endoscopists than with novice endoscopists.
Aside from learning basic diagnosis of colorectal neoplasms, magnifying endoscopy may have substantial clinical benefit for novice endoscopists.
放大内镜对新手内镜医师来说具有一定难度，因为它既需要内镜诊断方面的知识，又需要内镜诊断方面的技能。本研究旨在检查新手内镜医师确定结直肠肿瘤浸润深度的诊断性能，并将其与专家进行比较。
本研究为回顾性分析。共招募了 30 名使用放大内镜（窄带成像[NBI]和 pit 形态分析）的专家和 30 名新手内镜医师参与在线调查。新手内镜医师的定义为具有 <5 年放大内镜经验的内镜医师。评估了 3 个结果：（a）新手和专家内镜医师在确定肿瘤浸润深度方面的诊断准确性；（b）与非放大白光成像（WLI）相比，新手内镜医师在使用放大 NBI 或 pit 形态学确定肿瘤浸润深度方面的额外诊断准确性；（c）新手和专家内镜医师在每种检查模式下对诊断的信心程度差异。
专家内镜医师的曲线下面积（AUC）明显高于新手内镜医师。无论新手内镜医师如何确定病变特征，pit 形态学的 AUC 均明显高于 WLI。专家内镜医师的高置信度回答比例明显高于新手内镜医师。
除了学习结直肠肿瘤的基本诊断外，放大内镜可能对新手内镜医师具有显著的临床益处。
