Background and Aims
An e-learning system teaching endoscopic diagnostic process for early gastric cancer
using magnifying endoscopy with narrow-band imaging (M-NBI) was established, and its
efficacy in improving the diagnostic performance for early gastric cancer was proven
in a multicenter randomized controlled trial. The aim of this study was to clarify
the difference in learning effect in each lesion characteristic.
Methods
Three hundred sixty-five participants diagnosed 40 gastric lesions based on M-NBI
findings using the vessel-plus-surface classification system. The diagnosis data collected
from each participant were assessed in this study. The accuracy of NBI cancer diagnosis
was assessed using area under the receiver operating characteristics curve (AUC/ROC)
analysis. AUC/ROCs were separately calculated in each lesion characteristic (shape
and size), and the data were compared between tests 1 and 3.
Results
Continuous net reclassification improvement (cNRI) analysis of all lesions revealed
significant improvement in reclassification when participants underwent e-learning
(cNRI, 1.17; P < .01). The integrated discrimination improvement analysis demonstrated that the
e-learning system improved diagnostic ability (.19; P < .01). According to the analysis depending on the lesion’s characteristics, high
AUC/ROCs were demonstrated in depressed and small lesions (<10 mm; .90 and .93, respectively).
The cNRI analysis showed remarkable e-learning improvement in both depressed (cNRI,
1.33; P < .01) and small lesions (cNRI, 1.46; P < .01). However, no significant e-learning improvement was observed in elevated or
flat lesions.
Conclusions
In M-NBI education for endoscopists, a good learning outcome was obtained in depressed
and small lesions, but a poor learning outcome was demonstrated in elevated and flat
lesions. (Clinical trial registration number: UMIN000008569.)
Abbreviations:
AUC (area under the curve), AUC/ROC (area under the receiver operating characteristic curve), cNRI (continuous net reclassification improvement), DL (demarcation line), EGC (early gastric cancer), IDI (integrated discrimination improvement), MS (microsurface), M-NBI (magnifying endoscopy with narrow-band imaging), MV (microvascular), VSCS (vessel-plus-surface classification system), WOS (white opaque substance)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 26, 2019
Accepted:
April 16,
2019
Received:
December 28,
2018
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. Research support for this study (H.D.) was provided by a grant from the Japanese Foundation for Research and Promotion of Endoscopy and the Central Research Institute for Endoscopy, Fukuoka University.
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
