Background and Aims
Targeting neoplasia in Barrett’s esophagus (BE) is challenging. Volumetric laser endomicroscopy
(VLE) is a new imaging technique that allows for real time cross-sectional microstructure
imaging that can detect BE neoplasia. The interobserver agreement among users in practice
is unknown.
Methods
Eight high-volume users of VLE from different academic centers in the United States
evaluated 120 stored VLE images blinded to the endoscopic and clinical findings. There
were 30 images for each tissue type: gastric cardia, esophageal squamous mucosa, nonneoplastic
BE, and neoplastic BE. Each image with BE had corresponding histology confirming the
tissue diagnosis. Each normal esophagus and gastric cardia had matching endoscopic
images confirming normal mucosa. These were considered the criterion standard. Respondents
were asked to classify the images into 1 of each category. Agreement among the users
was measured.
Results
The overall agreement among users was almost perfect (kappa = 0.81; 95% confidence
interval [CI], 0.79-0.83). For esophageal squamous and gastric cardia, the agreement
was almost perfect (kappa 0.95 and 0.86, respectively [95% CI, 0.92-0.98 and 0.83-0.89]).
For nonneoplastic BE and neoplastic BE, the agreement was strong (kappa 0.66 [95%
CI, 0.63-0.69] and 0.79 [95% CI, 0.75-0.82], respectively). When compared with the
criterion standard, the median accuracy for identifying normal squamous mucosa, normal
gastric mucosa, nonneoplastic BE, neoplastic BE, and all tissue types was 99% (95%
CI, 98%-100%), 97% (95% CI, 95%-99%), 93% (95% CI, 88%-98%), 95% (95% CI, 91%-99%),
and 96% (95% CI, 94%-99%), respectively.
Conclusions
VLE has a high level of agreement and accuracy among high-volume users.
Abbreviations:
BE (Barrett’s esophagus), OCT (optical coherence tomography), VLE (volumetric laser endomicroscopy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 26, 2016
Accepted:
November 16,
2016
Received:
August 2,
2016
Footnotes
DISCLOSURE: K. Chang, C. Lightdale, C. Leggett, M. Smith, and M. Wallace receive research funding from NinePoint Medical. D. Pleskow and M. Smith are consultants for NinePoint Medical. Massachusetts General Hospital has a licensing arrangement with NinePoint Medical. G. Tearney has the right to receive royalties from this licensing arrangement. G. Tearney also receives grants from the Bill and Melinda Gates Foundation and iLumen Medical. All other 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 Trindade at [email protected]
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© 2017 by the American Society for Gastrointestinal Endoscopy
