TY - JOUR
T1 - Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett's esophagus
T2 - A prospective tandem study
AU - Giacchino, Maria
AU - Bansal, Ajay
AU - Kim, Raymond E.
AU - Singh, Vikas
AU - Hall, Sandy B.
AU - Singh, Mandeep
AU - Rastogi, Amit
AU - Moloney, Brian
AU - Wani, Sachin B.
AU - Gaddam, Srinivas
AU - Mathur, Sharad C.
AU - Wallace, Michael B.
AU - Kanakadandi, Vijay
AU - Balasubramanian, Gokulakrishnan
AU - Gupta, Neil
AU - Sharma, Prateek
PY - 2013/5
Y1 - 2013/5
N2 - Background: New endoscopic imaging techniques, such as autofluorescence imaging (AFI) and narrow-band imaging (NBI), have been developed to improve the detection of neoplastic lesions in Barrett's esophagus (BE). Objective: To evaluate the clinical utility of AFI and magnification NBI to detect high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) and the interobserver agreement. Design: Prospective tandem study of eligible patients. Setting: Single, academic tertiary care center. Patients: Forty-two patients with a history of confirmed BE were prospectively enrolled. Interventions: The BE segment was examined under high-definition white-light endoscopy, and the presence of visible lesions was recorded. Subsequently, AFI and magnification NBI were performed in tandem on areas of the BE segment away from visible lesions; images obtained by these 2 systems were graded according to the color of reflected light and surface patterns, respectively. Biopsy specimens were obtained at the end of the procedure. Main Outcome Measurements: The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of the AFI and NBI patterns for the detection of HGD/EAC and interobserver agreement. Results: Of the 42 patients enrolled, 14 (33%) had HGD/EAC. On patient-based analysis, AFI alone had a sensitivity, specificity, and NPV of 50%, 61%, and 71%, respectively, and the overall accuracy for the detection of HGD/EAC patients was 57%. By using magnification NBI in tandem fashion, the sensitivity and NPV improved to 71% and 76%, respectively, with a decrease in specificity to 46% and in overall accuracy to 55%. The 2 techniques had moderate interobserver agreement for both the patterns and prediction of histology. Limitations: Uncontrolled study performed at an academic center by expert endoscopists in a high-risk population. Conclusions: By using a multimodality endoscope, both AFI and magnification NBI had limited clinical accuracy and moderate overall interobserver agreement. AFI does not appear to be useful as a broad-based technique for the detection of neoplasia in patients with BE.
AB - Background: New endoscopic imaging techniques, such as autofluorescence imaging (AFI) and narrow-band imaging (NBI), have been developed to improve the detection of neoplastic lesions in Barrett's esophagus (BE). Objective: To evaluate the clinical utility of AFI and magnification NBI to detect high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) and the interobserver agreement. Design: Prospective tandem study of eligible patients. Setting: Single, academic tertiary care center. Patients: Forty-two patients with a history of confirmed BE were prospectively enrolled. Interventions: The BE segment was examined under high-definition white-light endoscopy, and the presence of visible lesions was recorded. Subsequently, AFI and magnification NBI were performed in tandem on areas of the BE segment away from visible lesions; images obtained by these 2 systems were graded according to the color of reflected light and surface patterns, respectively. Biopsy specimens were obtained at the end of the procedure. Main Outcome Measurements: The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of the AFI and NBI patterns for the detection of HGD/EAC and interobserver agreement. Results: Of the 42 patients enrolled, 14 (33%) had HGD/EAC. On patient-based analysis, AFI alone had a sensitivity, specificity, and NPV of 50%, 61%, and 71%, respectively, and the overall accuracy for the detection of HGD/EAC patients was 57%. By using magnification NBI in tandem fashion, the sensitivity and NPV improved to 71% and 76%, respectively, with a decrease in specificity to 46% and in overall accuracy to 55%. The 2 techniques had moderate interobserver agreement for both the patterns and prediction of histology. Limitations: Uncontrolled study performed at an academic center by expert endoscopists in a high-risk population. Conclusions: By using a multimodality endoscope, both AFI and magnification NBI had limited clinical accuracy and moderate overall interobserver agreement. AFI does not appear to be useful as a broad-based technique for the detection of neoplasia in patients with BE.
KW - AFI
KW - BE
KW - Barrett's esophagus
KW - CI
KW - EAC
KW - HD-WLE
KW - HGD
KW - IM
KW - IND
KW - LGD
KW - NBI
KW - NPV
KW - SD
KW - SD-WLE
KW - WLE
KW - autofluorescence imaging
KW - confidence interval
KW - esophageal adenocarcinoma
KW - high-definition white-light endoscopy
KW - high-grade dysplasia
KW - indefinite for dysplasia
KW - intestinal metaplasia
KW - low-grade dysplasia
KW - narrow-band imaging
KW - negative predictive value
KW - standard deviation
KW - standard-definition white-light endoscopy
KW - white-light endoscopy
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U2 - 10.1016/j.gie.2013.01.029
DO - 10.1016/j.gie.2013.01.029
M3 - Article
C2 - 23433595
AN - SCOPUS:84876153384
SN - 0016-5107
VL - 77
SP - 711
EP - 718
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -