Narrow-band imaging and white-light endoscopy with optical magnification in the diagnosis of dysplasia in Barrett's esophagus: results of the Asia-Pacific Barrett's Consortium

Rajvinder Singh, Mahesh Jayanna, Jennie Wong, Lee Guan Lim, Jun Zhang, Jing Lv, Dong Liu, Yi-Chia Lee, Ming-Lun Han, Ping-Huei Tseng, Vikneswaran Namasivayam, Rupa Banerjee, Noriya Uedo, Wah Kheong Chan, Shiaw Hooi Ho, Shi-Yao Chen, Shobna Bhatia, Kohei Funasaka, Takafumi Ando, Justin Wu, Cosmas Lesmana, William Tam, Wen-Lun Wang, Chi-Yang Chang, Hwoon-Yong Jung, Kee Wook Jung, Muhammad Begawan Bestari, Kenshi Yao, Vui Heng Chong, Prateek Sharma, Khek-Yu Ho, Rajvinder Singh, Mahesh Jayanna, Jennie Wong, Lee Guan Lim, Jun Zhang, Jing Lv, Dong Liu, Yi-Chia Lee, Ming-Lun Han, Ping-Huei Tseng, Vikneswaran Namasivayam, Rupa Banerjee, Noriya Uedo, Wah Kheong Chan, Shiaw Hooi Ho, Shi-Yao Chen, Shobna Bhatia, Kohei Funasaka, Takafumi Ando, Justin Wu, Cosmas Lesmana, William Tam, Wen-Lun Wang, Chi-Yang Chang, Hwoon-Yong Jung, Kee Wook Jung, Muhammad Begawan Bestari, Kenshi Yao, Vui Heng Chong, Prateek Sharma, Khek-Yu Ho

Abstract

Objective: The advent and utility of new endoscopic imaging modalities for predicting the histology of Barrett's esophagus (BE) in real time with high accuracy appear promising and could potentially obviate the need to perform random biopsies where guidelines are poorly adhered to. We embarked on evaluating the performance characteristics of white-light endoscopy with magnification (WLE-z), narrow-band imaging with magnification (NBI-z) and a combination of both modalities.

Design: This was a prospective online study with 28 endoscopists from 11 countries (Asia-Pacific region) participating as assessors. In total, 35 patients with BE were assessed using 150 slides from WLE-z and NBI-z randomly arranged using a simple classification with corresponding histology. The overall Accuracy (Acc), Sensitivity (Sn), Specificity (Sp), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of WLE-z, NBI-z and a combination of both were calculated.

Results: The overall Acc for WLE-z and NBI-z images was 87.1 % and 88.7 %, respectively. When images from the two modalities were placed side by side, the Acc increased to 90.3 %. The Sn, Sp, PPV, and NPV of WLE-z were 48 %, 92 %, 45 %, and 93 % while with NBI-z, these improved to 89 %, 89 %, 56 %, and 98 %, respectively. When both imaging modalities were viewed together, they improved further to 93 %, 90 %, 61 %, and 99 %.

Conclusion: The high NPV (99 %) when both WLE-z and NBI-z were used simultaneously indicates that areas with regular appearance that are diagnosed with confidence can effectively be left alone and not biopsied when performed at a skilled resourced center. This approach could potentially lead to a paradigm shift of how patients with BE are assessed.

Conflict of interest statement

Competing interests: None

Figures

Fig. 1
Fig. 1
Round pits and regular microvasculature (no dysplasia).
Fig. 2
Fig. 2
Ridge/villous pits and regular microvasculature (no dysplasia).
Fig. 3
Fig. 3
Absent pits and regular microvasculature (no dysplasia).
Fig. 4
Fig. 4
Irregular/absent pits and irregular microvasculature (high grade dysplasia).
Fig. 5
Fig. 5
Dilated vasculature but no change in caliber (equivocal).

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Source: PubMed

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