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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(08): E1045-E1052
DOI: 10.1055/a-1843-0334
Original article

Which factors make Barrett’s esophagus lesions difficult to diagnose?

Ippei Tanaka
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Dai Hirasawa
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Kenjiro Suzuki
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Syuhei Unno
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Shin Inoue
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Satoshi Ito
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Jyunichi Togashi
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Junichi Akahira
2   Department of Anatomic Pathology, Sendai Kousei Hospital, Miyagi, Japan
,
Fumiyoshi Fujishima
3   Department of Anatomic Pathology, Tohoku University School of Medicine, Miyagi, Japan
,
Tomoki Matsuda
1   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
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Abstract

Background and study aims Although the Japan Esophageal Society’s magnifying endoscopic classification for Barrett’s epithelium (JES-BE) offers high diagnostic accuracy, some cases are challenging to diagnose as dysplastic or non-dysplastic in daily clinical practice. Therefore, we investigated the diagnostic accuracy of this classification and the clinicopathological features of Barrett’s esophagus cases that are difficult to diagnose correctly.

Patients and methods Five endoscopists with experience with fewer than 10 cases of magnifying observation for superficial Barrett’s esophageal carcinoma reviewed 132 images of Barrett’s mucosa or carcinoma (75 dysplastic and 57 non-dysplastic cases) obtained using high-definition magnification endoscopy with narrow-band imaging (ME-NBI). They diagnosed each image as dysplastic or non-dysplastic according to the JES-BE classification, and the diagnostic accuracy was calculated. To identify risk factors for misdiagnosed images, images with a correct rate of less than 40 % were defined as difficult-to-diagnose, and those with 60 % or more were defined as easy-to-diagnose. Logistic regression analysis was performed to identify risk factors for difficult-to-diagnose images.

Results The sensitivity, specificity and overall accuracy were 67 %, 80 % and 73 %, respectively. Of the 132 ME-NBI images, 34 (26 %) were difficult-to-diagnose and 99 (74 %) were easy-to-diagnose. Logistic regression analysis showed low-grade dysplasia (LGD) and high-power magnification images were each significant risk factors for difficult-to-diagnose images (OR: 6.80, P = 0.0017 and OR: 3.31, P = 0.0125, respectively).

Conclusions This image assessment study suggested feasibility of the JES-BE classification for diagnosis of Barrett’s esophagus by non-expert endoscopists and risk factors for difficult diagnosis as high-power magnification and LGD histology. For non-experts, high-power magnification images are better evaluated in combination with low-power magnification images.



Publication History

Received: 23 October 2021

Accepted after revision: 03 May 2022

Accepted Manuscript online:
04 May 2022

Article published online:
15 August 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Pohl H, Sirovich B, Welch HG. Esophageal adenocarcinoma incidence: are we reaching the peak?. Cancer Epidemiol Biomark Prev 2010; 19: 1468-1470
    CrossrefPubMedGoogle Scholar
  • 2 Devesa SS, Blot WJ, Fraumeni Jr JF. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998; 83: 2049-2053
    CrossrefPubMedGoogle Scholar
  • 3 Fujiwara Y, Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population. J Gastroenterol 2009; 44: 518-534
    CrossrefPubMedGoogle Scholar
  • 4 Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: orient to occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol 2009; 24: 729-735
    CrossrefPubMedGoogle Scholar
  • 5 Hur C, Miller M, Kong CY. et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013; 119: 1149-1158
    CrossrefPubMedGoogle Scholar
  • 6 Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA 2013; 310: 627-636
    CrossrefPubMedGoogle Scholar
  • 7 Sharma P, Sidorenko EI. Are screening and surveillance for Barrett’s oesophagus really worthwhile?. Gut 2005; 54: i27-i32
    CrossrefPubMedGoogle Scholar
  • 8 Shaheen NJ, Falk GW, Iyer PG. et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111: 30-50
    CrossrefPubMedGoogle Scholar
  • 9 Abrams JA, Kapel RC, Lindberg GM. et al. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol 2009; 7: 736-742
    CrossrefPubMedGoogle Scholar
  • 10 Kato M, Goda K, Shimizu Y. et al. Image assessment of Barrett’s esophagus using the simplified narrow band imaging classification. J Gastroenterol 2017; 52: 466-475
    CrossrefPubMedGoogle Scholar
  • 11 Singh R, Anagnostopoulos GK, Yao K. et al. Narrow-band imaging with magnification in Barrett’s esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy 2008; 40: 457-463
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Sharma P, Bansal A, Mathur S. et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett’s esophagus. Gastrointest Endosc 2006; 64: 167-175
    CrossrefPubMedGoogle Scholar
  • 13 Anagnostopoulos GK, Yao K, Kaye P. et al. Novel endoscopic observation in Barrett’s oesophagus using high resolution magnification endoscopy and narrow band imaging. Aliment Pharmacol Ther 2007; 26: 501-507
    CrossrefPubMedGoogle Scholar
  • 14 Kara MA, Ennahachi M, Fockens P. et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc 2006; 64: 155-166
    CrossrefPubMedGoogle Scholar
  • 15 Goda K, Fujisaki J, Ishihara R. et al. Newly developed magnifying endoscopic classification of the Japan Esophageal Society to identify superficial Barrett’s esophagus-related neoplasms. Esophagus 2018; 15: 153-159
    CrossrefPubMedGoogle Scholar
  • 16 Ishihara R, Goda K, Oyama T. Endoscopic diagnosis and treatment of esophageal adenocarcinoma: introduction of Japan Esophageal Society classification of Barrett’s esophagus. J Gastroenterol 2019; 54: 1-9
    CrossrefPubMedGoogle Scholar
  • 17 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
    Google Scholar
  • 18 Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968; 70: 213-220
    Google Scholar
  • 19 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378-382
    CrossrefPubMedGoogle Scholar
  • 20 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
    Google Scholar
  • 21 Riddell RH, Goldman H, Ransohoff DF. et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983; 14: 931-968
    CrossrefPubMedGoogle Scholar
  • 22 Schmidt HG, Riddell RH, Walther B. et al. Dysplasia in Barrett’s esophagus. J Cancer Res Oncol 1985; 110: 145-152
    CrossrefPubMedGoogle Scholar
  • 23 Montgomery E, Bronner MP, Goldblum JR. et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol 2001; 32: 368-378
    CrossrefPubMedGoogle Scholar
  • 24 Odze RD. Diagnosis and grading of dysplasia in Barrett’s oesophagus. J Clin Pathol 2006; 59: 1029-1038
    CrossrefPubMedGoogle Scholar
  • 25 Sharma P, Hawes RH, Bansal A. et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett oesophagus: a prospective, international, randomized controlled trial. Gut 2013; 62: 15-21
    Google Scholar
  • 26 Probst A, Aust D, Märkl B. et al. Endoscopic submucosal dissection in early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 2015; 47: 113-121
    PubMedGoogle Scholar
  • 27 Shimizu T, Fujisaki J, Omae M. et al. Treatment outcomes of endoscopic submucosal dissection for adenocarcinoma originating from long-segment Barrett’s esophagus versus short-segment Barrett’s esophagus. Digestion 2018; 97: 316-323
    CrossrefPubMedGoogle Scholar
  • 28 Oyama T, Takahashi A, Yorimitsu N. et al. Endoscopic Diagnosis of Superficial Barrett’s Esophageal Adenocarcinoma. Stomach Intestine 2016; 51: 1322-1332
    PubMedGoogle Scholar
  • 29 Ezoe Y, Muto M, Uedo N. et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 2011; 141: 2017-2025
    CrossrefPubMedGoogle Scholar
  • 30 Wouter L, Curvers F, ten Kate J. et al. Low-grade dysplasia in Barrett’s esophagus: Overdiagnosed and underestimated. Am J Gastro 2010; 105: 1523-1530
    CrossrefPubMedGoogle Scholar