Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jul;72(1):19-24.
doi: 10.1016/j.gie.2010.01.053. Epub 2010 Apr 8.

Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy

Michael B Wallace  1 , Prateek Sharma, Charles Lightdale, Herbert Wolfsen, Emmanuel Coron, Anna Buchner, Monther Bajbouj, Ajay Bansal, Amit Rastogi, Julian Abrams, Julia E Crook, Alexander Meining
Affiliations

Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy

Michael B Wallace et al. Gastrointest Endosc. 2010 Jul.

Abstract

Background: Confocal laser endomicroscopy (CLE) is a rapidly emerging method for in vivo imaging of the GI tract.

Objective: To determine the preliminary evaluation accuracy and interobserver agreement of probe-based CLE (pCLE) in Barrett's esophagus (BE).

Design: Prospective, double-blind review of pCLE images of 40 sites of BE tissue by using matching biopsies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 20 unknown images.

Setting: Eleven experts in BE imaging from 4 different endoscopy centers from the United States and Europe evaluated the images.

Patients: This study involved nonconsecutive patients undergoing BE surveillance or evaluation of high-grade intraepithelial neoplasia or early adenocarcinoma.

Intervention: Intravenous fluorescein pCLE imaging of each site within the BE segment, followed by matching biopsy.

Main outcome measurements: Sensitivity, specificity, and agreement for the pCLE diagnosis of high-grade intraepithelial neoplasia or carcinoma.

Results: In the validation set (n = 20), 11 cases had high-grade intraepithelial neoplasia or invasive carcinoma. The sensitivity for the diagnosis of neoplasia for the 11 endoscopists was 88% (range 6 of 11 to 11 of 11), and the specificity was 96% (range 7 of 9 to 9 of 9). There was substantial agreement on the pCLE diagnosis (86%, kappa 0.72; 95% confidence interval, 0.58-0.86). Endomicroscopists with prior pCLE experience had an overall sensitivity of 91% (all 10 of 11), specificity of 100% (all 9 of 9), and almost perfect agreement (92%, kappa 0.83; 95% confidence interval, 0.64-1.0).

Limitations: Small sample size and use of offline video sequences.

Conclusion: Results suggest that pCLE for the diagnosis of neoplasia in BE has very high accuracy and reliability.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Probe-based confocal laser endomicroscopy images of Barrett’s esophagus without neoplasia.
Figure 2
Figure 2
Probe-based confocal laser endomicroscopy images of Barrett’s esophagus without neoplasia.
Figure 3
Figure 3
Probe-based confocal laser endomicroscopy images of Barrett’s esophagus with high-grade intraepithelial neoplasia. Arrows (>) indicate areas of dark, irregularly thickened, epithelial borders that are characteristic of dysplasia.
Figure 4
Figure 4
Probe-based confocal laser endomicroscopy images of Barrett’s esophagus with high-grade intraepithelial neoplasia. Arrows (>) indicate areas of dark, irregularly thickened, epithelial borders that are characteristic of dysplasia.
See this image and copyright information in PMC

References

    1. Cameron AJ. Epidemiology of columnar-lined esophagus and adenocarcinoma. Gastroenterol Clin North Am. 1997;26:487–94. - PubMed
    1. Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol. 2008;103:788–97. - PubMed
    1. Sampliner RE. Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol. 2002;97:1888–95. - PubMed
    1. Becker V, von Delius S, Bajbouj M, et al. Intravenous application of fluorescein for confocal laser scanning microscopy: evaluation of contrast dynamics and image quality with increasing injection-to-imaging time. Gastrointest Endosc. 2008;68:319–23. - PubMed
    1. Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5. - PMC - PubMed

MeSH terms