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Publication Detail
Virtual chromoendoscopy using optical enhancement improves the detection of Barrett's esophagus-associated neoplasia.
Abstract
BACKGROUND AND AIMS: The Seattle protocol for endoscopic Barrett's esophagus surveillance samples a small proportion of the mucosal surface area - risking a potentially high miss rate of early neoplastic lesions. We assess if the new iScan Optical Enhancement system (OE, Pentax) improves the detection of early BE associated neoplasia compared with high definition white light endoscopy (HD-WLE) in both expert and trainee endoscopists to target sampling of suspicious areas. Such a system may both improve early neoplasia detection and reduce the need for random biopsies. METHODS: 41 patients undergoing endoscopic BE surveillance from Jan 2016-Nov 2017 were recruited from 3 international referral centers. Matched still images in both HD-WLE (n=130) and iScan OE (n=132) were obtained from endoscopic examinations. Two experts, unblinded to the videos and histology, delineated known neoplasia, forming a consensus criterion standard. 7 expert and 7 trainee endoscopists marked one position per image where they would expect a target biopsy to identify dysplastic tissue. The same expert panel then reviewed magnification images and using a previously validated classification system attempted to classify mucosa as dysplastic or non-dysplastic based on the mucosal and vascular patterns observed on magnification endoscopy. Diagnostic accuracy, sensitivity, specificity, NPV, and PPV were calculated. Improvements in dysplasia detection in HD-WLE vs OE and interobserver agreement (IA) were assessed by multilevel logistic regression analysis and Krippendorff's alpha, respectively. Improvements in diagnostic performance were expressed as an odds ratio between the odds of an improvement in OE, compared with the odds of an improvement in WLE RESULTS: Accuracy of neoplasia detection was significantly higher in all trainees using OE versus WLE (76% vs 63%) and in 6 experts (84% vs 77%). OE improved sensitivity of dysplasia detection compared with WLE in 6 trainees (81% vs 71%) and 5 experts (77% vs 67%). Specificity improved in 6 trainees using OE vs WLE (70% vs 55%) and in 5 experts (92% vs 86%). PPV improved in both an expert and trainee cohort but NPV only improved significantly in trainees. Using the MV classification and OE magnification endoscopy compared with HD-WLE, we demonstrated improvements in accuracy (79.9% vs 66.7%), sensitivity (86.3% vs 83.4%) and specificity (71.2% vs 53.6%) of dysplasia detection. PPV improved (62% to 76.6%), as did NPV (67.7% to 78.5%).Interobserver agreement also improved using OE from 0.30 to 0.55. CONCLUSION: iScan OE may improve dysplasia detection on endoscopic imaging of BE, as well as the accuracy of histology prediction compared with HD-WLE, when using OE magnification endoscopy in conjunction with a simple classification system in both expert and non-expert endoscopists.
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