The learning curve, accuracy, and interobserver agreement of endoscope-based confocal laser endomicroscopy for the differentiation of colorectal lesions

Kuiper, Teaco; Kießlich, Ralf; Ponsioen, Cyriel Y.; Fockens, Paul; Dekker, Evelien

doi:10.1016/j.gie.2012.01.040

Cited by 45 publications

(44 citation statements)

References 25 publications

(23 reference statements)

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“…Studies indicate that accurate interpretation of optical biopsies follows a learning curve, and this learning curve can be achieved rapidly in both academic and community practice settings. [54][55][56][57][58][59] This ASGE Technology Committee systematic review and meta-analysis therefore confirms that the thresholds established by the ASGE PIVI for the real-time endoscopic assessment of the histology of diminutive polyps have been met, at least for NBI, with endoscopists who are experts in using these advanced imaging technologies and when assessments are made with high confidence. The ASGE Technology Committee therefore endorses the use of NBI for both the "diagnose-and-leave" strategy for diminutive rectosigmoid hyperplastic polyps and the "resect-and-discard" strategy for diminutive adenomatous polyps by endoscopists trained in using this technology for polyp characterization, making assessments with high confidence.…”

Section: Group By Expertsupporting

confidence: 62%

ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

Dayyeh¹,

Thosani²,

Konda³

et al. 2015

Gastrointestinal Endoscopy

314

252

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Section: Group By Expertsupporting

confidence: 62%

ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

Dayyeh¹,

Thosani²,

Konda³

et al. 2015

Gastrointestinal Endoscopy

314

252

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“…Similar to previous studies[16]–[17], we examined confidence in the image reading process. Accuracy could be higher when observers were very confident of their classification (experienced 98.8%, inexperienced 94.7%).…”

Section: Discussionmentioning

confidence: 96%

“…Kuiper et al[17] demonstrated that differentiating colorectal lesions in CLE images can be learned quickly with a detailed description of the Mainz classification and a set of 10 images. The learning curve with CLE images for predicting colorectal neoplasia was evaluated among a wide range of gastrointestinal specialists [18].…”

Section: Discussionmentioning

confidence: 99%

Learning Curve and Interobserver Agreement of Confocal Laser Endomicroscopy for Detecting Precancerous or Early-Stage Esophageal Squamous Cancer

Liu

et al. 2014

PLoS ONE

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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.

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“…In fact, time to expertise, with >90% accuracy, as well as final sustained sensitivity, specificity and accuracy favored HRME compared to studies done in either probe-based and endoscope-based CLE systems 5152 . Relatedly, the post-training accuracy values reached by the endoscopists who were not experts in HRME were not inferior to those shown by the HRME experts.…”

Section: Introductionmentioning

confidence: 93%

High-resolution microendoscopy in differentiating neoplastic from non-neoplastic colorectal polyps

Louie

Shukla

Richards‐Kortum

et al. 2015

Best Practice & Research Clinical Gastroenterology

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Colorectal cancer is one of the leading causes of death worldwide. The progression from adenoma to cancer is a well known phenomenon. Current clinical practice favors colonoscopy as the preferred modality for colorectal cancer screening. Many novel endoscopic technologies are emerging for the purposes of performing “optical biopsy” to allow real-time histologic diagnosis of polyps. High resolution microendoscopy is a low-cost endoscopic technology that has demonstrated high sensitivity and specificity in differentiating neoplastic and non-neoplastic polyps. With the ability to make real-time conclusions based on the endoscopic appearance of polyps, it is becoming increasingly possible to decrease the rate of unnecessary polypectomies and utilize a “resect and discard” strategy to decrease costs of pathology evaluation. Future directions for this technology include surveillance of premalignant conditions such as inflammatory bowel disease. Moreover, the low cost and relative ease of use of this technology lends itself to widespread applicability.

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The learning curve, accuracy, and interobserver agreement of endoscope-based confocal laser endomicroscopy for the differentiation of colorectal lesions

Cited by 45 publications

References 25 publications

ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

Learning Curve and Interobserver Agreement of Confocal Laser Endomicroscopy for Detecting Precancerous or Early-Stage Esophageal Squamous Cancer

High-resolution microendoscopy in differentiating neoplastic from non-neoplastic colorectal polyps

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