The Learning Curve of Gastric Intestinal Metaplasia Interpretation on the Images Obtained by Probe-Based Confocal Laser Endomicroscopy

Abstract

Background. Reading the results of gastric intestinal metaplasia (GIM) with probe-based confocal laser endomicroscopy (pCLE) by the expert was excellent. There is a lack of study on the learning curve for GIM interpretation. Therefore, we conducted a study to explore the learning curve in the beginners. Material and Method. Five GI fellows who had no experience in GIM interpretation had been trained with a set of 10 pCLE video clips of GIM and non-GIM until they were able to interpret correctly. Then they were asked to interpret another 80 video clips of GIM and non-GIM. The sensitivity, specificity, accuracy, PPV, NPV, and interobserver agreement on each session were analyzed. Results. Within 2 sessions, all beginners can achieve 80% accuracy with substantial to almost perfect level of interobserver agreement. The sensitivities and specificities among all interpreters were not different statistically. Four out of five interpreters can maintain their high quality of reading skill. Conclusion. After a short session of training on GIM interpretation of pCLE images, the beginners can achieve a high level of reading accuracy with at least substantial level of interobserver agreement. Once they achieve the high reading accuracy, almost all can maintain their high quality of reading skill.

Probe‐based confocal laser endomicroscopy (pCLE) – a new imaging technique for in situ localization of spermatozoa

“…Fluorescein Alcon, which is clinically approved for intravenous application and is regularly applied for pCLE in the gastrointestinal tract [19,20], is suitable to stain spermatozoa after topical application after incision of the tunica albuginea. After staining the spermatozoa generally stay motile.…”

“…As in all new imaging techniques, there is an associated learning curve for the interpreter [19] to identify all cells of spermatogenesis as displayed by pCLE. In the near future the interpretation might be facilitated by staining spermatozoa with a spermspecific FITC labelled antibody.…”

“…PCLE enables in vivo microscopy of tissues by mean of flexible miniaturized fiberoptic probes of 1.5 to 2.6 mm outer diameter inserted through the working channel of a standard endoscope. Up to now, pCLE has been approved for clinical use in the respiratory tract [17,18] and in the gastrointestinal tract [19,20]. First studies have already been reported in the pancreaticobiliary system [21,22] and in the urinary tract [23].…”

Advanced endoscopic imaging in gastric neoplasia and preneoplasia

“…The agreement between interpretation by experienced endoscopists and histology for gastric intestinal metaplasia was also higher than that for inexperienced endoscopists (K=0.864 vs 0.217). Pittayanon et al 47 demonstrated that trainees with no experience in intestinal metaplasia interpretation could achieve high reading accuracy and substantial interobserver agreement after training with 10 sets of CLE video clips. Trainees on achieving high reading accuracy were shown to maintain their high quality of reading skill.…”

Confocal Microscopy in the Esophagus and Stomach

“…Guo et al19 additionally demonstrated 98% sensitivity and 95% specificity for GIM using confocal microscopy. Notably, the learning curve for pCLE detection of GIM is short, typically obtaining acceptable intraobserver agreement with 1 to 2 hours of training 21. Yet to be explored is whether pCLE can improve the diagnosis of dysplasia following gastric endoscopic mucosal resection or endoscopic submucosal resection.…”