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Medline ® Abstract for Reference 89

of 'Barrett's esophagus: Surveillance and management'

Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett's esophagus with probe-based confocal laser endomicroscopy.
Wallace MB, Sharma P, Lightdale C, Wolfsen H, Coron E, Buchner A, Bajbouj M, Bansal A, Rastogi A, Abrams J, Crook JE, Meining A
Gastrointest Endosc. 2010;72(1):19. Epub 2010 Apr 8.
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 studyinvolved 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.
Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.