Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
Department of Gastroenterology, Catharina Hospital, Eindhoven, Netherlands.
Gastrointest Endosc. 2020 Feb;91(2):310-320. doi: 10.1016/j.gie.2019.09.035. Epub 2019 Oct 3.
Detecting subtle Barrett's neoplasia during surveillance endoscopy can be challenging. Blue-light imaging (BLI) is a novel advanced endoscopic technology with high-intensity contrast imaging that may improve the identification of Barrett's neoplasia. The aim of this study was to develop and validate the first classification to enable characterization of neoplastic and non-neoplastic Barrett's esophagus using BLI.
In phase 1, descriptors pertaining to neoplastic and non-neoplastic Barrett's esophagus were identified to form the classification, named the Blue Light Imaging for Barrett's Neoplasia Classification (BLINC). Phase 2 involved validation of these component criteria by 10 expert endoscopists assessing 50 BLI images. In phase 3, a web-based training module was developed to enable 15 general (nonexpert) endoscopists to use BLINC. They then validated the classification with an image assessment exercise in phase 4, and their pre- and post-training results were compared.
In phase 1 the descriptors were grouped into color, pit, and vessel pattern categories to form the classification. In phase 2 the sensitivity of neoplasia identification was 96.0% with a very good level of agreement among the experts (κ = .83). In phase 3, 15 general endoscopists completed the training module. In phase 4 their pretraining sensitivity (85.3%) improved significantly to 95.7% post-training with a good level of agreement (κ = .67).
We developed and validated a new classification system (BLINC) for the optical diagnosis of Barrett's neoplasia using BLI. Despite the limitations of this image-based study with a high prevalence of neoplasia, we believe it has the potential to improve the optical diagnosis of Barrett's neoplasia given the high degree of sensitivity (96%) noted. It is also a promising tool for training in Barrett's esophagus optical diagnosis using BLI.
在监测内镜检查中检测到微妙的 Barrett 肿瘤可能具有挑战性。蓝光成像（BLI）是一种新型的高级内镜技术，具有高强度对比度成像，可提高 Barrett 肿瘤的识别能力。本研究的目的是开发和验证第一个分类，以使用 BLI 对 Barrett 食管的肿瘤和非肿瘤进行特征描述。
在第 1 阶段，确定了与 Barrett 食管的肿瘤和非肿瘤相关的描述符，形成了该分类，命名为用于 Barrett 肿瘤的蓝光成像分类（BLINC）。第 2 阶段涉及 10 名专家内镜医师评估 50 个 BLI 图像，验证这些组成标准。在第 3 阶段，开发了一个基于网络的培训模块，使 15 名普通（非专家）内镜医师能够使用 BLINC。然后，他们在第 4 阶段的图像评估练习中验证了该分类，并比较了他们的培训前后结果。
在第 1 阶段，将描述符分为颜色、凹陷和血管模式类别，形成分类。在第 2 阶段，肿瘤识别的敏感性为 96.0%，专家之间的一致性非常好（κ=0.83）。在第 3 阶段，15 名普通内镜医师完成了培训模块。在第 4 阶段，他们的预培训敏感性（85.3%）显著提高到 95.7%，一致性良好（κ=0.67）。
我们使用 BLI 开发并验证了用于 Barrett 肿瘤光学诊断的新型分类系统（BLINC）。尽管这项基于图像的研究存在局限性，并且肿瘤的患病率很高，但我们认为，鉴于注意到的高敏感性（96%），它有可能改善 Barrett 肿瘤的光学诊断。它也是使用 BLI 进行 Barrett 食管光学诊断培训的有前途的工具。
