Reliability of Paris Classification for superficial neoplastic gastric lesions improves with training and narrow band imaging

Abstract

Background and study aims Paris Classification is used to classify gastrointestinal superficial neoplastic lesions and to predict presence of submucosal invasion. We aimed to evaluate interobserver reliability and agreement for this classification among Western endoscopists.

Methods A total of 54 superficial gastric lesions were independently classified according to Paris classification by eight endoscopists (4 experts and 4 non-experts). Observers were asked to classify two sets of images – first, obtained with high-resolution white light (HR-WL) endoscopy and secondly, with the same HR-WL images paired with images obtained with high-resolution Narrow Band Imaging (HR-NBI) – HR-WL + NBI image group.

Results Overall interobserver reliability when asked to classify in I, II or III was good both using HR-WL images and HR-WL + NBI images (wK of 0.65 and 0.70, respectively). The proportion of agreement for type III lesions was 0.48 for HR-WL images increasing to 0.74 in the HR-WL + NBI group. Interobserver reliability for identification of a IIc component was only moderate (wK 0,47). NBI improves both sensitivity and interobserver reliability among trainees (from wK 0.19 to 0.47). Specificity was higher than sensitivity in predicting submucosal invasion.

Conclusion Overall, the reliability of Paris classification is moderate to good. Training on this classification or its revision and use of technology such as NBI may improve not only reliability and agreement but also accuracy.

• References

• 1 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
• 2 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
• 3 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
• 4 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386
• 5 Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesions in the Digestive Tract. Endoscopy 2005; 37: 570-578
• 6 Kim EH, Park JC, Song IJ. et al. Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer. Gastrointest Endosc 2017; 85: 976-983
• 7 Toyokawa T, Inaba T, Omote S. et al. Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions. Exp Ther Med 2015; 9: 1209-1214
• 8 Pimentel-Nunes P, Libânio D, Dinis-Ribeiro M. Evaluation and management of gastric superficial neoplastic lesions. GE - Port J Gastroenterol 2017; 24: 8-21
• 9 Pimentel-Nunes P, Dinis-Ribeiro M, Soares J. et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy 2012; 44: 236-246
• 10 Boeriu A, Boeriu C, Drasovean S. et al. Narrow-band imaging with magnifying endoscopy for the evaluation of gastrointestinal lesions. World J Gastrointest Endosc 2015; 16: 110-120
• 11 Kottner J, Audigé L, Brorson S. et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol 2011; 64: 96-106
• 12 Grant JM. The fetal heart rate trace is normal, isn’t it? Observer agreement of categorical assessments. Lancet 1991; 337: 215-218
• 13 Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol 1990; 43: 543-549
• 14 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 15 Henriques T, Antunes L, Bernardes J. et al. Information-based measure of disagreement for more than two observers: a useful tool to compare the degree of observer disagreement. BMC Med Res Methodol 2013; 13: 47
• 16 Kwee RM, Kwee TC. Predicting lymph node status in early gastric cancer. Gastric Cancer 2008; 11: 134-148
• 17 Jung DH, Park YM, Kim JH. et al. Clinical implication of endoscopic gross appearance in early gastric cancer: Revisited. Surg Endosc Other Interv Tech 2013; 27: 3690-3695
• 18 Ferlay J, Shin HR, Bray F. et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN. Int J Cancer 2010; 127: 2893-2917
• 19 Hirasawa K, Kokawa A, Oka H. et al. Risk assessment chart for curability of early gastric cancer with endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 1268-1275
• 20 Vindigni C, Marini M, Cevenini G. et al. Italy-Japan agreement and discrepancies in diagnosis of superficial gastric lesions. Front Biosci (Elite Ed) 2010; 2: 733-738
• 21 van Doorn SC, Hazewinkel Y, East JE. et al. Polyp morphology: an interobserver evaluation for the Paris classification among international experts. Am J Gastroenterol 2015; 110: 180-187