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Endoscopy. 2018 May;50(5):471-478. doi: 10.1055/s-0043-121569. Epub 2017 Nov 27.

Learning curve and competence for volumetric laser endomicroscopy in Barrett's esophagus using cumulative sum analysis.

Author information

1
Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Long Island Jewish Medical Center, New Hyde Park, New York, United States.
2
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States.
3
Icahn School of Medicine at Mount Sinai, Mount Sinai West and Mount Sinai St. Luke's Hospitals, New York, New York, United States.
4
Division of Biostatistics, Hofstra Northwell School of Medicine, Northwell Health System, Feinstein Institute for Medical Research, Manhasset, New York, United States.
5
H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States.
6
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States.
7
Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States.
8
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
9
Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States.
10
Department of Pathology, Harvard Medical School, Boston, Massachusetts, United States.
11
Massachusetts General Hospital, Boston, Massachusetts, United States.
12
Harvard-MIT Division of Health Sciences Technology, Cambridge, Massachusetts, United States.
13
Department of Pathology, Hofstra Northwell School of Medicine, Northwell Health System, Long Island Jewish Medical Center, New Hyde Park, New York, United States.
14
Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, United States.

Abstract

BACKGROUND AND STUDY AIMS:

Little is known about the learning curve for image interpretation in volumetric laser endomicroscopy (VLE) in Barrett's esophagus (BE). The goal of this study was to calculate the learning curve, competence of image interpretation, sensitivity, specificity, and accuracy of VLE among novice users.

METHODS:

31 novice users viewed 96 VLE images electronically at three academic institutions after a brief training session. There were 24 images of each histologic type: normal gastric cardia, normal esophageal squamous epithelium, non-neoplastic BE, and neoplastic BE. The users were asked to identify the correct tissue type and level of confidence. The cumulative summation (CUSUM) technique was used to construct a learning curve.

RESULTS:

22 (71 %) of the physicians achieved VLE interpretation competency during their 96-slide review. Half of the physicians achieved competency at 65 images (95 % confidence interval [CI] 45 - 85). There was a statistically significant association between confidence in diagnosis and selecting the correct histologic tissue type (P < 0.001). The median accuracy for esophageal squamous epithelium, normal gastric cardia, non-neoplastic BE, and neoplastic BE was 96 % (95 %CI 95 % - 96 %), 95 % (95 %CI 94 % - 96 %), 90 % (95 %CI 88 % - 91 %), 96 % (95 %CI 95 % - 96 %). The overall accuracy was 95 % (95 %CI 93 % - 95 %).

CONCLUSION:

The majority of novice users achieved competence in image interpretation of VLE for BE, using a pre-selected image set, with a favorable learning curve after a brief training session. An electronic review of VLE images, prior to real-time use of VLE, is encouraged.

PMID:
29179229
DOI:
10.1055/s-0043-121569
[Indexed for MEDLINE]

Conflict of interest statement

K.J.C., C.J.L., C.L.L., M.S.S., and M.B.W. have received research funding from Ninepoint Medical. D.K.P. and M.S.S. are consultants for Ninepoint Medical. G.J.T. (Massachusetts General Hospital) has a licensing arrangement with NinePoint Medical, and has the right to receive royalties from this licensing arrangement.G.J.T. also receives grants from the Bill and Melinda Gates Foundation and iLumen Medical.

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