Background and Aims
Confocal laser endomicroscopy can dynamically assess intestinal mucosal barrier defects
and increased intestinal permeability (IP). These are functional features that do
not have corresponding appearance on histopathology. As such, previous pathology training
may not be beneficial in learning these dynamic features. This study aims to evaluate
the diagnostic accuracy, learning curve, inter- and intraobserver agreement for identifying
features of increased IP in experienced and inexperienced analysts and pathologists.
Methods
A total of 180 endoscopic confocal laser endomicroscopy (Pentax EC-3870FK; Pentax,
Tokyo, Japan) images of the terminal ileum, subdivided into 6 sets of 30 were evaluated
by 6 experienced analysts, 13 inexperienced analysts, and 2 pathologists, after a
30-minute teaching session. Cell-junction enhancement, fluorescein leak, and cell
dropout were used to represent increased IP and were either present or absent in each
image. For each image, the diagnostic accuracy, confidence, and quality were assessed.
Results
Diagnostic accuracy was significantly higher for experienced analysts compared with
inexperienced analysts from the first set (96.7% vs 83.1%, P < .001) to the third set (95% vs 89.7, P = .127). No differences in accuracy were noted between inexperienced analysts and
pathologists. Confidence (odds ratio, 8.71; 95% confidence interval, 5.58-13.57) and
good image quality (odds ratio, 1.58; 95% confidence interval, 1.22-2.03) were associated
with improved interpretation. Interobserver agreement κ values were high and improved
with experience (experienced analysts, 0.83; inexperienced analysts, 0.73; and pathologists,
0.62). Intraobserver agreement was >0.86 for experienced observers.
Conclusion
Features representative of increased IP can be rapidly learned with high inter- and
intraobserver agreement. Confidence and image quality were significant predictors
of accurate interpretation. Previous pathology training did not have an effect on
learning.
Abbreviations:
CDO (cell dropout), CI (confidence interval), CJE (cell-junction enhancement), CLE (confocal laser endomicroscopy), CLS (confocal leak score), eCLE (endoscopic confocal laser endomicroscopy), FL (fluorescein leak), IBD (inflammatory bowel disease), IP (intestinal permeability), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 03, 2015
Accepted:
August 26,
2015
Received:
January 27,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Leong at [email protected]
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
