教育讲座对日本 NBI 专家分类法诊断结直肠病变准确性的影响。

Effect of educational lecture on the diagnostic accuracy of Japan NBI Expert Team classification for colorectal lesions.

机构信息

Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

出版信息

BMC Gastroenterol. 2021 Mar 5;21(1):110. doi: 10.1186/s12876-021-01676-x.

DOI:10.1186/s12876-021-01676-x

PMID:33663383

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7934459/

Abstract

BACKGROUND

An educational and training program is required for generalization of Japan NBI Expert Team (JNET) classification. However, there is no detailed report on the learning curve of the diagnostic accuracy of endoscopists using JNET classification. We examined the effect of an educational lecture on beginners and less experienced endoscopists for improving their diagnostic accuracy of colorectal lesions by JNET classification.

METHODS

Seven beginners with no endoscopy experience (NEE group), 7 less experienced endoscopists (LEE group), and 3 highly experienced endoscopists (HEE group) performed diagnosis using JNET classification for randomized NBI images of colorectal lesions from 180 cases (Type 1: 22 cases, Type 2A: 105 cases, Type 2B: 33 cases, and Type 3: 20 cases). Next, the NEE and LEE groups received a lecture on JNET classification, and all 3 groups repeated the diagnostic process. We compared the correct diagnosis rate and interobserver agreement before and after the lecture comprehensively and for each JNET type.

RESULTS

In the HEE group, the correct diagnosis rate was more than 90% with good interobserver agreements (kappa value: 0.78-0.85). In the NEE and LEE groups, the correct diagnosis rate (NEE: 60.2 → 68.0%, P < 0.01; LEE: 66.4 → 86.7%, P < 0.01), high-confidence correct diagnosis rate (NEE: 19.6 → 37.2%, P < 0.01; LEE: 43.6 → 61.1%, P < 0.01), and interobserver agreement (kappa value, NEE: 0.32 → 0.43; LEE: 0.39 → 0.75) improved after the lecture. In the examination by each JNET type, the specificity and positive predictive value in the NEE and LEE groups generally improved after the lecture.

CONCLUSION

After conducting an appropriate lecture, the diagnostic ability using JNET classification was improved in beginners or endoscopists with less experience in NBI magnifying endoscopy.

摘要

背景

为了推广日本 NBI 专家团队（JNET）分类，需要进行教育和培训计划。然而，目前还没有关于内镜医师使用 JNET 分类诊断准确性学习曲线的详细报告。我们研究了教育讲座对内镜检查经验较少的初学者和内镜医师提高其使用 JNET 分类诊断结直肠病变的准确性的效果。

方法

7 名无内镜经验的初学者（NEE 组）、7 名内镜经验较少的内镜医师（LEE 组）和 3 名经验丰富的内镜医师（HEE 组）对来自 180 例患者的随机 NBI 图像进行 JNET 分类诊断（1 型：22 例，2A 型：105 例，2B 型：33 例，3 型：20 例）。接下来，NEE 和 LEE 组接受了 JNET 分类讲座，所有 3 组均重复诊断过程。我们综合比较了讲座前后的正确诊断率和观察者间一致性，并针对每个 JNET 类型进行了比较。

结果

在 HEE 组中，观察者间一致性良好（kappa 值：0.78-0.85），正确诊断率超过 90%。在 NEE 和 LEE 组中，正确诊断率（NEE：60.2→68.0%，P<0.01；LEE：66.4→86.7%，P<0.01）、高置信度正确诊断率（NEE：19.6→37.2%，P<0.01；LEE：43.6→61.1%，P<0.01）和观察者间一致性（kappa 值，NEE：0.32→0.43；LEE：0.39→0.75）在讲座后有所提高。在每种 JNET 类型的检查中，NEE 和 LEE 组的特异性和阳性预测值在讲座后普遍提高。