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
Comparative Study
. 2014 Dec 21;20(47):17993-8000.
doi: 10.3748/wjg.v20.i47.17993.

Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings

Shajan Peter  1 , Leona Council  1 , Ji Young Bang  1 , Helmut Neumann  1 , Klaus Mönkemüller  1 , Shyam Varadarajulu  1 , Charles Melbern Wilcox  1
Affiliations
Comparative Study

Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings

Shajan Peter et al. World J Gastroenterol. .

Abstract

Aim: To compare the interpretation of probe-based confocal laser endomicroscopy (pCLE) findings between endoscopists and gastrointestinal (GI)-pathologists.

Methods: All pCLE procedures were undertaken and the endoscopist rendered assessment. The same pCLE videos were then viewed offline by an expert GI pathologist. Histopathology was considered the gold standard for definitive diagnosis. The sensitivity, specificity and accuracy for diagnosis of dysplastic/ neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for pCLE findings were analyzed.

Results: Of the 66 included patients, 40 (60.6%) had lesions in the esophagus, 7 (10.6%) in the stomach, 15 (22.7%) in the biliary tract, 3 (4.5%) in the ampulla and 1 (1.5%) in the colon. The overall sensitivity, specificity and accuracy for diagnosing dysplastic/neoplastic lesions using pCLE were higher for endoscopists than pathologist at 87.0% vs 69.6%, 80.0% vs 40.0% and 84.8% vs 60.6% (P = 0.0003), respectively. Area under the ROC curve (AUC) was greater for endoscopists than the pathologist (0.83 vs 0.55, P = 0.0001). Overall agreement between endoscopists and pathologist was moderate for all GI lesions (K = 0.43; 95%CI: 0.26-0.61), luminal lesions (K = 0.40; 95%CI: 0.20-0.60) and those of dysplastic/neoplastic pathology (K = 0.55; 95%CI: 0.37-0.72), the agreement was poor for benign (K = 0.13; 95%CI: -0.097-0.36) and pancreaticobiliary lesions (K = 0.19; 95%CI: -0.26-0.63).

Conclusion: There is a wide discrepancy in the interpretation of pCLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions. Further studies are needed to identify the cause of this poor agreement.

Keywords: Confocal endomicroscopy; Gastointestinal; Interobserver variation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Probe-based confocal laser endomicroscopy images of Barrett’s esophagus. A: Barrett‘s esophagus with intestinal metaplasia; B: Barrett‘s esophagus with dysplasia; C: Barrett‘s esophagus with neoplasia or carcinoma.
Figure 2
Figure 2
Flow chart for interpretation of results. A: Anatomical site; B: Interpretation of Cellvizio image. pCLE: Probe-based confocal laser endomicroscopy.
Figure 3
Figure 3
Flowchart of patient recruitment. pCLE: Probe-based confocal laser endomicroscopy; PPV: Positive predictive value; NPV: Negative predictive value.
Figure 4
Figure 4
Receiver operating characteristic curves for endoscopists and pathologist for diagnosis of dysplastic/neoplastic lesions using probe-based confocal laser endomicroscopy.
See this image and copyright information in PMC

References

    1. Sharma P, Montgomery E. Gastrointestinal dysplasia. Pathology. 2013;45:273–285. - PubMed
    1. Calhoun BC, Gomes F, Robert ME, Jain D. Sampling error in the standard evaluation of endoscopic colonic biopsies. Am J Surg Pathol. 2003;27:254–257. - PubMed
    1. Kiesslich R, Gossner L, Goetz M, Dahlmann A, Vieth M, Stolte M, Hoffman A, Jung M, Nafe B, Galle PR, et al. In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol. 2006;4:979–987. - PubMed
    1. Kiesslich R, Goetz M, Vieth M, Galle PR, Neurath MF. Confocal laser endomicroscopy. Gastrointest Endosc Clin N Am. 2005;15:715–731. - PubMed
    1. Neumann H, Kiesslich R, Wallace MB, Neurath MF. Confocal laser endomicroscopy: technical advances and clinical applications. Gastroenterology. 2010;139:388–392, 392.e1-e2. - PubMed

Publication types

LinkOut - more resources