Abstract
BackgroundConfocal laser endomicroscopy (CLE) can provide in vivo subcellular resolution images of esophageal lesions. However, the learning curve in interpreting CLE images of precancerous or early-stage esophageal squamous cancer is unknown. The goal of this study is to evaluate the diagnostic accuracy and inter-observer agreement for differentiating esophageal lesions in CLE images among experienced and inexperienced observers and to assess the learning curve.MethodAfter a short training, 8 experienced and 14 inexperienced endoscopists evaluated in sequence 4 sets of high-quality CLE images. Their diagnoses were corrected and discussed after each set. For each image, the diagnostic results, confidence in diagnosis, quality and time to evaluate were recorded.ResultsOverall, diagnostic accuracy was greater for the second, third, fourth set of images as compared with the initial set (odds ratio [OR] 2.01, 95% CI 1.22–3.31; 7.95, 3.74–16.87; and 6.45, 3.14–13.27), respectively, with no difference between the third and fourth sets in accuracy (p = 0.67). Previous experience affected the diagnostic accuracy only in the first set of images (OR 3.70, 1.87–7.29, p<0.001). Inter-observer agreement was higher for experienced than inexperienced endoscopists (0.732 vs. 0.666, p<0.01)ConclusionCLE is a promising technology that can be quickly learned after a short training period; previous experience is associated with diagnostic accuracy only at the initial stage of learning.
Highlights
Esophageal cancer is an important cause of cancer-related deaths worldwide
Overall, diagnostic accuracy was greater for the second, third, fourth set of images as compared with the initial set, respectively, with no difference between the third and fourth sets in accuracy (p = 0.67)
Confocal laser endomicroscopy (CLE) is a promising technology that can be quickly learned after a short training period; previous experience is associated with diagnostic accuracy only at the initial stage of learning
Summary
In 2008, there was an estimated 482,300 new esophageal cancer cases, and 406,800 patients died from the disease worldwide[1]. Detection of the premalignant state of the disease, such as esophageal squamous intraepithelial neoplasia, and early-stage disease can improve survival [3]. Standard endoscopy by itself cannot reliably detect squamous dysplasia or early-stage esophageal cancer because of inconspicuous macroscopic appearance of lesions[4]. Confocal laser endomicroscopy (CLE) can provide in vivo subcellular resolution images of esophageal lesions. The learning curve in interpreting CLE images of precancerous or early-stage esophageal squamous cancer is unknown. The goal of this study is to evaluate the diagnostic accuracy and inter-observer agreement for differentiating esophageal lesions in CLE images among experienced and inexperienced observers and to assess the learning curve
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