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Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: Impact of structured learning and experience on the accuracy of the Amsterdam classification system

Baldaque-Silva, Francisco; Marques, Margarida; Lunet, Nuno; Themudo, Goncalo; Goda, Kenichi; Toth, Ervin LU ; Soares, Jose; Bastos, Pedro; Ramalho, Rosa and Pereira, Pedro, et al. (2013) In Scandinavian Journal of Gastroenterology 48(2). p.160-167
Abstract
Objective. Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. Material & methods: Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with... (More)
Objective. Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. Material & methods: Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given. Results. Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia. Conclusion: Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice. (Less)
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organization
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Contribution to journal
publication status
published
subject
keywords
barrett's esophagus, magnification endoscopy, narrow band imaging, neoplasia
in
Scandinavian Journal of Gastroenterology
volume
48
issue
2
pages
160 - 167
publisher
Taylor & Francis
external identifiers
  • wos:000313675600004
  • scopus:84872698010
ISSN
1502-7708
DOI
10.3109/00365521.2012.746392
language
English
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yes
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9c6ab8ff-5c17-495b-a9cf-56e25551dfd5 (old id 3470494)
date added to LUP
2013-03-01 07:45:21
date last changed
2019-05-14 02:56:01
@article{9c6ab8ff-5c17-495b-a9cf-56e25551dfd5,
  abstract     = {Objective. Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. Material & methods: Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given. Results. Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia. Conclusion: Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice.},
  author       = {Baldaque-Silva, Francisco and Marques, Margarida and Lunet, Nuno and Themudo, Goncalo and Goda, Kenichi and Toth, Ervin and Soares, Jose and Bastos, Pedro and Ramalho, Rosa and Pereira, Pedro and Marques, Nuno and Coimbra, Miguel and Vieth, Michael and Dinis-Ribeiro, Mario and Macedo, Guilherme and Lundell, Lars and Marschall, Hanns-Ulrich},
  issn         = {1502-7708},
  keyword      = {barrett's esophagus,magnification endoscopy,narrow band imaging,neoplasia},
  language     = {eng},
  number       = {2},
  pages        = {160--167},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: Impact of structured learning and experience on the accuracy of the Amsterdam classification system},
  url          = {http://dx.doi.org/10.3109/00365521.2012.746392},
  volume       = {48},
  year         = {2013},
}