Interpretation of Probe-Based Confocal Laser Endomicroscopy of Indeterminate Biliary Strictures: Is There Any Interobserver Agreement?

Abstract

The overall interobserver agreement for pCLE image interpretation in indeterminate biliary strictures ranges from poor to fair. Interpretation criteria as well as training require further standardization toward improving inter-rater reliability.

Pre‐ and post‐training session evaluation for interobserver agreement and diagnostic accuracy of probe‐based confocal laser endomicroscopy for biliary strictures

“…Despite the standardization of an image classification system, the use of pCLE is limited by poor overall agreement of interobserver image interpretation in biliary disease. In a prior multicenter pilot study, we demonstrated that agreement ranged from ‘poor’ to ‘fair’ despite using the MC and controlling for procedural experience . Thus, interpretation standardization and further physician training is required to improve interobserver reliability of pCLE imaging.…”

“…Whereas pCLE carries tremendous diagnostic potential in the evaluation of indeterminate biliary strictures, its use in practice requires consistency among endoscopists. Prior research has suggested a need for interobserver studies using defined criteria to further confirm the benefits of pCLE for indeterminate strictures . Our 2012 study evaluated the interobserver agreement of pCLE imaging interpretation to diagnose and classify benign and malignant lesions of the biliary tract based on the Miami classification (MC) .…”

Endoscopic assessment and management of biliary strictures

“…A recent series found a sensitivity of 100%, specificity of 69%, positive predictive value of 60%, negative predictive value of 100% and overall accuracy of 79% for discriminating malignant from benign biliary strictures when pCLE is combined with endobiliary and EUS-guided tissue acquisition 27. However, given recent reports of significant interobserver variation,28 these findings remain to be replicated in adequately designed randomised studies.…”

Microscopic imaging in endoscopy: endomicroscopy and endocytoscopy

“…39 However, these encouraging data were followed by lower accuracy reported from follow-up trials. 40,41 Such thin pCLE probes have also been studied in the pancreatic duct, 42 and even introduced through needles placed by endoscopic ultrasonography into pancreatic cystic lesions. 43 Large studies are necessary to fully evaluate the value of CLE in these settings.…”