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

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.

Publikationsverlauf

Eingereicht: 23. Oktober 2021

Angenommen nach Revision: 03. Mai 2022

Accepted Manuscript online:
04. Mai 2022

Artikel online veröffentlicht:
15. August 2022

• References

• 1 Pohl H, Sirovich B, Welch HG. Esophageal adenocarcinoma incidence: are we reaching the peak?. Cancer Epidemiol Biomark Prev 2010; 19: 1468-1470
• 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
• 3 Fujiwara Y, Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population. J Gastroenterol 2009; 44: 518-534
• 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
• 5 Hur C, Miller M, Kong CY. et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013; 119: 1149-1158
• 6 Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA 2013; 310: 627-636
• 7 Sharma P, Sidorenko EI. Are screening and surveillance for Barrett’s oesophagus really worthwhile?. Gut 2005; 54: i27-i32
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 17 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
• 18 Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968; 70: 213-220
• 19 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378-382
• 20 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 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
• 22 Schmidt HG, Riddell RH, Walther B. et al. Dysplasia in Barrett’s esophagus. J Cancer Res Oncol 1985; 110: 145-152
• 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
• 24 Odze RD. Diagnosis and grading of dysplasia in Barrett’s oesophagus. J Clin Pathol 2006; 59: 1029-1038
• 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
• 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
• 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
• 28 Oyama T, Takahashi A, Yorimitsu N. et al. Endoscopic Diagnosis of Superficial Barrett’s Esophageal Adenocarcinoma. Stomach Intestine 2016; 51: 1322-1332
• 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
• 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