A Web-Based Education Program for Colorectal Lesion Diagnosis with Narrow Band Imaging Classification

Abstract

Background: An education system for narrow band imaging (NBI) interpretation requires sufficient exposure to key features. However, access to didactic lectures by experienced teachers is limited in the United States. Aim: To develop and assess the effectiveness of a colorectal lesion identification tutorial. Methods: In the image analysis pretest, subjects including 9 experts and 8 trainees interpreted 50 white light (WL) and 50 NBI images of colorectal lesions. Results were not reviewed with subjects. Trainees then participated in an online tutorial emphasizing NBI interpretation in colorectal lesion analysis. A post-test was administered and diagnostic yields were compared to pre-education diagnostic yields. Results: Under the NBI mode, experts showed higher diagnostic yields (sensitivity 91.5% [87.3–94.4], specificity 90.6% [85.1–94.2], and accuracy 91.1% [88.5–93.7] with substantial interobserver agreement [κ value 0.71]) compared to trainees (sensitivity 89.6% [84.8–93.0], specificity 80.6% [73.5–86.3], and accuracy 86.0% [82.6–89.2], with substantial interobserver agreement [κ value 0.69]). The online tutorial improved the diagnostic yields of trainees to the equivalent level of experts (sensitivity 94.1% [90.0–96.6], specificity 89.0% [83.0–93.2], and accuracy 92.0% [89.3–94.7], p < 0.001 with substantial interobserver agreement [κ value 0.78]). Conclusions: This short, online tutorial improved diagnostic performance and interobserver agreement.

Training methods in optical diagnosis and characterization of colorectal polyps: a systematic review and meta-analysis

“…After preliminary screen-ing of titles and abstracts, 113 were selected for full text review. Of these, 16 papers [4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] (before 2010 n = 1, 2010-2015 n = 7, 2016-2019 n = 8) matched the selection criteria and were included in the systematic review. Of these studies, seven were from Europe [4,17,21,23,[26][27][28], six from North America [14,16,[18][19][20], 24] and three from Asia [15,22,25].…”

“…Of these studies, seven were from Europe [4,17,21,23,[26][27][28], six from North America [14,16,[18][19][20], 24] and three from Asia [15,22,25]. Among included studies, eight reported on didactic training [4, 14-16, 18, 22, 23, 27], seven on computer-based self-training [17,[19][20][21][24][25][26] and one on computer-based self-training vs. didactic training [28]. The majority of studies were observational in design (n = 14) and there were two randomized trials [18,28].…”

“…Overall 11 studies were based on NBI system [14-22, 24, 25], one on iScan [26] and one on BLI (Blue Light Imaging) [27], two on NBI and iScan [4,28] and one on high-definition white light (HDWL)/chromoendoscopy [23]. Sixteen studies reported pre-training and post-training values, two studies included trainees [4,28], eight included fully qualified/BCSP (Bowel Cancer Screening Programme) endoscopists [14,15,[18][19][20][21][22]25] and six studies included both groups [16,17,23,24,26,27]. There were nine studies that only included small/diminutive colorectal polyps [4,15,17,19,20,[25][26][27][28].…”

“…A total of eight studies [4,16,17,23,24,[26][27][28] = 0.02; Chi 2 = 242.86, df = 16 (P < 0.00001); I 2 = 93 % Test for overall effect: Z = 4.62 (P < 0.00001) Test for subgroup differences: Chi 2 = 0.02, df = 1 (P = 0.89), I 2 = 0 % 0.…”

“…Smith Samuel CL et al Training methods in … Endosc Int Open 2021; 09: E716-E726 | © 2021. The Author(s).When pooling together all studies, polyp sizes (16 studies, 179 participants)[4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27], assessing the efficacy of any method of optical diagnosis training, pooled pre-training accuracy was 70.3 % (6416/9131 correct diagnoses) vs. post-training accuracy was 81.6 % (7416/9213 correct diagnoses) (RR 1.17 95 % CI 1.09-1.24 P < 0.001) (▶ Fig.2). The 95 % prediction interval was 0.85-1.61.…”