Prospective Study
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World J Gastroenterol. Dec 21, 2014; 20(47): 17993-18000
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17993
Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings
Shajan Peter, Leona Council, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox
Shajan Peter, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL 35294-0012, United States
Leona Council, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294-0012, United States
Helmut Neumann, Department of Medicine 1, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Author contributions: All authors contributed to the manuscript.
Correspondence to: Shajan Peter, MD, Associate Professor, Division of Gastroenterology and Hepatology, University of Alabama, 1808 7th Avenue South, BDB 380, Birmingham, AL 35294-0012, United States. shajan@uab.edu
Telephone: +1-205-9964059 Fax: +1-205-9756381
Received: January 24, 2014
Revised: April 3, 2014
Accepted: July 15, 2014
Published online: December 21, 2014
Processing time: 330 Days and 12.7 Hours
Abstract

AIM: To compare the interpretation of probe-based confocal laser endomicroscopy (pCLE) findings between endoscopists and gastrointestinal (GI)-pathologists.

METHODS: All pCLE procedures were undertaken and the endoscopist rendered assessment. The same pCLE videos were then viewed offline by an expert GI pathologist. Histopathology was considered the gold standard for definitive diagnosis. The sensitivity, specificity and accuracy for diagnosis of dysplastic/ neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for pCLE findings were analyzed.

RESULTS: Of the 66 included patients, 40 (60.6%) had lesions in the esophagus, 7 (10.6%) in the stomach, 15 (22.7%) in the biliary tract, 3 (4.5%) in the ampulla and 1 (1.5%) in the colon. The overall sensitivity, specificity and accuracy for diagnosing dysplastic/neoplastic lesions using pCLE were higher for endoscopists than pathologist at 87.0% vs 69.6%, 80.0% vs 40.0% and 84.8% vs 60.6% (P = 0.0003), respectively. Area under the ROC curve (AUC) was greater for endoscopists than the pathologist (0.83 vs 0.55, P = 0.0001). Overall agreement between endoscopists and pathologist was moderate for all GI lesions (K = 0.43; 95%CI: 0.26-0.61), luminal lesions (K = 0.40; 95%CI: 0.20-0.60) and those of dysplastic/neoplastic pathology (K = 0.55; 95%CI: 0.37-0.72), the agreement was poor for benign (K = 0.13; 95%CI: -0.097-0.36) and pancreaticobiliary lesions (K = 0.19; 95%CI: -0.26-0.63).

CONCLUSION: There is a wide discrepancy in the interpretation of pCLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions. Further studies are needed to identify the cause of this poor agreement.

Keywords: Confocal endomicroscopy; Gastointestinal; Interobserver variation

Core tip: Probe-based confocal endomicroscopy (pCLE) has emerged as a valuable tool in the diagnosis and management of gastrointestinal disorders. It has helped the endoscopist to make real time decisions and targeted biopsies. Histopathology still remains the gold standard. We compared the interpretation of pCLE findings between an endoscopist and a dedicated gastrointestinal pathologist and found there was a discrepency in the intepretation of the same findings between them. This is interesting as the endoscopist has a different approach of intepreting real time endomicroscopy compared to that of a pathologist.