Background and Aims
High-resolution microendoscopy (HRME) is an optical biopsy technology that provides
subcellular imaging of esophageal mucosa but requires expert interpretation of these
histopathology-like images. We compared endoscopists with an automated software algorithm
for detection of esophageal squamous cell neoplasia (ESCN) and evaluated the endoscopists’
accuracy with and without input from the software algorithm.
Methods
Thirteen endoscopists (6 experts, 7 novices) were trained and tested on 218 post-hoc
HRME images from 130 consecutive patients undergoing ESCN screening/surveillance.
The automated software algorithm interpreted all images as neoplastic (high-grade
dysplasia, ESCN) or non-neoplastic. All endoscopists provided their interpretation
(neoplastic or non-neoplastic) and confidence level (high or low) without and with
knowledge of the software overlay highlighting abnormal nuclei and software interpretation.
The criterion standard was histopathology consensus diagnosis by 2 pathologists.
Results
The endoscopists had a higher mean sensitivity (84.3%, standard deviation [SD] 8.0%
vs 76.3%, P = .004), lower specificity (75.0%, SD 5.2% vs 85.3%, P < .001) but no significant difference in accuracy (81.1%, SD 5.2% vs 79.4%, P = .26) of ESCN detection compared with the automated software algorithm. With knowledge
of the software algorithm, the specificity of the endoscopists increased significantly
(75.0% to 80.1%, P = .002) but not the sensitivity (84.3% to 84.8%, P = .75) or accuracy (81.1% to 83.1%, P = .13). The increase in specificity was among novices (P = .008) but not experts (P = .11).
Conclusions
The software algorithm had lower sensitivity but higher specificity for ESCN detection
than endoscopists. Using computer-assisted diagnosis, the endoscopists maintained
high sensitivity while increasing their specificity and accuracy compared with their
initial diagnosis. Automated HRME interpretation would facilitate widespread usage
in resource-poor areas where this portable, low-cost technology is needed.
Abbreviations:
ESCN (esophageal squamous cell neoplasia), HRME (high-resolution microendoscopy), LCE (Lugol’s iodine chromoendoscopy), PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations), SD (standard deviation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 16, 2020
Accepted:
July 2,
2020
Received:
February 17,
2020
Footnotes
DISCLOSURE: R. Richards-Kortum is an inventor on patents related to optical technologies owned by the University of Texas licensed to Remicalm LLC. All other authors disclosed no financial relationships.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
