Interpretation of Probe-Based Confocal Laser Endomicroscopy of Indeterminate Biliary Strictures: Is There Any Interobserver Agreement?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Probe-based confocal laser endomicroscopy (pCLE) has enabled in vivo histopathology by obtaining high resolution images of the mucosal layers of the gastrointestinal tract. For indeterminate bile duct strictures, biopsy, cytologic brushing and needle aspiration have low levels of diagnostic accuracy.
The objective of this multi-center pilot study was to assess the interobserver agreement in interpretation of pCLE imaging.
Twenty-five de-identified pCLE video clips of indeterminate biliary strictures were sent to 6 observers at 5 institutions. Miami Classification was used to standardize image interpretation. Seven variables were assessed for interobserver agreement using the Fleiss kappa statistic which included: presence of thick (>20 μm) or thin (<20 μm) dark or white bands, dark clumps, epithelium including glandular structures, interstitial fluorescein leakage, ease of interpretation, and final diagnosis. Based on operator experience, observers were categorized into 3 categories of experience (Category 1: 0–10; Category 2: 11–20; Category 3: >21 cases).
Upon stratification, Category 1 interobserver agreement ranged from “Poor” to “Fair” (κ = 0.277, κ = −0.079, κ = −0.025, κ = −0.066, κ = 0.128, κ = 0.088), and for the final diagnosis variable, the agreement was slight (κ = 0.033). Category 2 and 3 interobserver agreement ranged from “Poor” to “Fair” (κ = 0.211, κ = 0.181, κ = 0.347, κ = 0.238, κ = −0.050, κ = 0.092), and for the final diagnosis variable, the agreement was slight (κ = 0.195).
The overall interobserver agreement for pCLE image interpretation in indeterminate biliary strictures ranges from poor to fair. Interpretation criteria as well as training require further standardization toward improving inter-rater reliability.
- Bellis, M (2002) Tissue sampling at ERCP in suspected malignant biliary strictures (part 1). Gastrointest Endosc 56: pp. 552-561 CrossRef
- Gaidhane, M, Kahaleh, M (2011) Single-operator cholangioscopy in biliary disorders: going beyond visualization. Gastrointest Endosc 74: pp. 815-816 CrossRef
- Meining, A (2008) Detection of cholangiocarcinoma in vivo using miniprobe-based confocal fluorescence microscopy. Clin Gastroenterol Hepatol 6: pp. 1057-1060 CrossRef
- Rosch, T (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55: pp. 870-876 CrossRef
- Loeser, CS (2011) Confocal endomicroscopic examination of malignant biliary strictures and histologic correlation with lymphatics. J Clin Gastroenterol 45: pp. 246-252 CrossRef
- Palma, GD (2009) Confocal laser endomicroscopy in the “in vivo” histological diagnosis of the gastrointestinal tract. World J Gastroenterol 15: pp. 5770-5775 CrossRef
- Meining A et al. Direct visualization of indeterminate pancreaticobiliary strictures with probe-based confocal laser endomicroscopy: a multicenter experience. Gastrointest Endosc. 2011;74:961–968. Epub. 07/29/2011.
- Parsi, MA (2011) Peroral cholangioscopy in the new millennium. World J Gastroenterol 17: pp. 1-6 CrossRef
- Fogel, EL (2006) Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. Gastrointest Endosc 63: pp. 71-77 CrossRef
- Moreno Luna, LE (2006) Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures. Gastroenterology 131: pp. 1064-1072 CrossRef
- Fritcher, EG (2009) A multivariable model using advanced cytologic methods for the evaluation of indeterminate pancreatobiliary strictures. Gastroenterology 136: pp. 2180-2186 CrossRef
- Bellis, M (2002) Tissue sampling at ERCP in suspected malignant biliary strictures (part 2). Gastrointest Endosc 56: pp. 720-730 CrossRef
- Draganov PV et al. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest Endosc. 2011;73:971–979. Epub 03/17/2011.
- Othman, MO, Wallace, MB (2011) Confocal laser endomicroscopy: is it prime time?. J Clin Gastroenterol 45: pp. 205-206 CrossRef
- Wallace MB et al. Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett’s esophagus with probe-based confocal laser endomicroscopy. Gastrointest Endosc. 2010;72:19–24. Epub 04/08/2010.
- Buchner, AM (2011) The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia. Gastrointest Endosc 73: pp. 556-560 CrossRef
- Palma, GD (2011) In vivo characterization of DALM in ulcerative colitis with high-resolution probe-based confocal laser endomicroscopy. World J Gastroenterol 17: pp. 677-680 CrossRef
- Giovannini M et al. Results of a phase I-II study on intraductal confocal microscopy (IDCM) in patients with common bile duct (CBD) stenosis. Surg Endosc. 2011;25:2247–2253. Epub 03/18/2011.
- Interpretation of Probe-Based Confocal Laser Endomicroscopy of Indeterminate Biliary Strictures: Is There Any Interobserver Agreement?
Digestive Diseases and Sciences
Volume 57, Issue 12 , pp 3299-3302
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Probe-based confocal laser endomicroscopy
- Biliary stricture
- Diagnostic accuracy
- Industry Sectors
- Author Affiliations
- 1. Department of Digestive Health, University of Virginia, Charlottesville, VA, USA
- 2. Department of Gastroenterology, Columbia University Medical Center, New York, NY, USA
- 3. Department of Gastroenterology, Yale University, New Haven, CT, USA
- 4. Department of Gastroenterology, Boston University School of Medicine, Boston, MA, USA
- 5. Department of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
- 6. Department of Gastroenterology, BIDMC, Boston, MA, USA
- 7. Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA