A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma

Wen Lun Wang, Sherry Yueh Hsia Chiu, Ching Tai Lee, Cheng Hao Tseng, Chien Chuan Chen, Ming Lun Han, Chen Shuan Chung, Ping Hsin Hsieh, Wei-Lun Chang, Ping Hsiu Wu, Wen Hung Hsu, Hsu Heng Yen, Hsiu Po Wang, Chi Yang Chang

Research output: Contribution to journalArticle

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Abstract

Background and Aim: Optimal staging of the invasion depth of superficial esophageal squamous cell carcinoma is vital before endoscopic treatment. A new simplified magnified narrow-band imaging (M-NBI) classification system based on vascular architecture has recently been developed by the Japan Esophageal Society; however, its validity remains uncertain. Methods: A total of 11 experienced and 11 inexperienced endoscopists were invited to join an endoscopic training program, which was composed of pretest, educational section, and post-test. The pretest and post-test sections included a set of endoscopic photos from 40 subjects with superficial esophageal squamous cell carcinoma with various invasion depths. Each subject appeared twice in the test, one with white-light imaging (WLI) only and the other with both WLI and M-NBI. The educational section included lectures and video demonstrations. Results: The accuracy of WLI alone and combined with M-NBI at baseline were 0.53, 0.57 and 0.43, 0.41 for the experienced and inexperienced endoscopists, respectively, which then improved to 0.57, 0.63 and 0.49, 0.52 after training. Inter-observer agreement (k-value) of WLI alone and combined WLI and M-NBI for the experienced and inexperienced endoscopists also improved from 0.61, 0.61, and 0.61, 0.53 to 0.68, 0.71, and 0.71, 0.59, respectively. Multivariate analysis revealed that the educational course but not experience in endoscopy, NBI, or magnification significantly improved the diagnostic accuracy. M-NBI had a significant additional benefit to WLI, with an improvement in accuracy from 36% to 56% for the cases with m3/sm1 cancers (P < 0.05). Conclusions: A well-designed training program can improve the diagnostic accuracy in evaluating cancer invasion depth, with substantial agreement.

Original languageEnglish
Pages (from-to)1248-1255
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume33
Issue number6
DOIs
Publication statusPublished - 2018 Jun 1

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Narrow Band Imaging
Education
Light
Endoscopy
Blood Vessels
Esophageal Squamous Cell Carcinoma
Neoplasms
Japan
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Wang, Wen Lun ; Chiu, Sherry Yueh Hsia ; Lee, Ching Tai ; Tseng, Cheng Hao ; Chen, Chien Chuan ; Han, Ming Lun ; Chung, Chen Shuan ; Hsieh, Ping Hsin ; Chang, Wei-Lun ; Wu, Ping Hsiu ; Hsu, Wen Hung ; Yen, Hsu Heng ; Wang, Hsiu Po ; Chang, Chi Yang. / A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma. In: Journal of Gastroenterology and Hepatology (Australia). 2018 ; Vol. 33, No. 6. pp. 1248-1255.
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title = "A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma",
abstract = "Background and Aim: Optimal staging of the invasion depth of superficial esophageal squamous cell carcinoma is vital before endoscopic treatment. A new simplified magnified narrow-band imaging (M-NBI) classification system based on vascular architecture has recently been developed by the Japan Esophageal Society; however, its validity remains uncertain. Methods: A total of 11 experienced and 11 inexperienced endoscopists were invited to join an endoscopic training program, which was composed of pretest, educational section, and post-test. The pretest and post-test sections included a set of endoscopic photos from 40 subjects with superficial esophageal squamous cell carcinoma with various invasion depths. Each subject appeared twice in the test, one with white-light imaging (WLI) only and the other with both WLI and M-NBI. The educational section included lectures and video demonstrations. Results: The accuracy of WLI alone and combined with M-NBI at baseline were 0.53, 0.57 and 0.43, 0.41 for the experienced and inexperienced endoscopists, respectively, which then improved to 0.57, 0.63 and 0.49, 0.52 after training. Inter-observer agreement (k-value) of WLI alone and combined WLI and M-NBI for the experienced and inexperienced endoscopists also improved from 0.61, 0.61, and 0.61, 0.53 to 0.68, 0.71, and 0.71, 0.59, respectively. Multivariate analysis revealed that the educational course but not experience in endoscopy, NBI, or magnification significantly improved the diagnostic accuracy. M-NBI had a significant additional benefit to WLI, with an improvement in accuracy from 36{\%} to 56{\%} for the cases with m3/sm1 cancers (P < 0.05). Conclusions: A well-designed training program can improve the diagnostic accuracy in evaluating cancer invasion depth, with substantial agreement.",
author = "Wang, {Wen Lun} and Chiu, {Sherry Yueh Hsia} and Lee, {Ching Tai} and Tseng, {Cheng Hao} and Chen, {Chien Chuan} and Han, {Ming Lun} and Chung, {Chen Shuan} and Hsieh, {Ping Hsin} and Wei-Lun Chang and Wu, {Ping Hsiu} and Hsu, {Wen Hung} and Yen, {Hsu Heng} and Wang, {Hsiu Po} and Chang, {Chi Yang}",
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Wang, WL, Chiu, SYH, Lee, CT, Tseng, CH, Chen, CC, Han, ML, Chung, CS, Hsieh, PH, Chang, W-L, Wu, PH, Hsu, WH, Yen, HH, Wang, HP & Chang, CY 2018, 'A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma', Journal of Gastroenterology and Hepatology (Australia), vol. 33, no. 6, pp. 1248-1255. https://doi.org/10.1111/jgh.14071

A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma. / Wang, Wen Lun; Chiu, Sherry Yueh Hsia; Lee, Ching Tai; Tseng, Cheng Hao; Chen, Chien Chuan; Han, Ming Lun; Chung, Chen Shuan; Hsieh, Ping Hsin; Chang, Wei-Lun; Wu, Ping Hsiu; Hsu, Wen Hung; Yen, Hsu Heng; Wang, Hsiu Po; Chang, Chi Yang.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 33, No. 6, 01.06.2018, p. 1248-1255.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A training program of a new simplified classification of magnified narrow band imaging for superficial esophageal squamous cell carcinoma

AU - Wang, Wen Lun

AU - Chiu, Sherry Yueh Hsia

AU - Lee, Ching Tai

AU - Tseng, Cheng Hao

AU - Chen, Chien Chuan

AU - Han, Ming Lun

AU - Chung, Chen Shuan

AU - Hsieh, Ping Hsin

AU - Chang, Wei-Lun

AU - Wu, Ping Hsiu

AU - Hsu, Wen Hung

AU - Yen, Hsu Heng

AU - Wang, Hsiu Po

AU - Chang, Chi Yang

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background and Aim: Optimal staging of the invasion depth of superficial esophageal squamous cell carcinoma is vital before endoscopic treatment. A new simplified magnified narrow-band imaging (M-NBI) classification system based on vascular architecture has recently been developed by the Japan Esophageal Society; however, its validity remains uncertain. Methods: A total of 11 experienced and 11 inexperienced endoscopists were invited to join an endoscopic training program, which was composed of pretest, educational section, and post-test. The pretest and post-test sections included a set of endoscopic photos from 40 subjects with superficial esophageal squamous cell carcinoma with various invasion depths. Each subject appeared twice in the test, one with white-light imaging (WLI) only and the other with both WLI and M-NBI. The educational section included lectures and video demonstrations. Results: The accuracy of WLI alone and combined with M-NBI at baseline were 0.53, 0.57 and 0.43, 0.41 for the experienced and inexperienced endoscopists, respectively, which then improved to 0.57, 0.63 and 0.49, 0.52 after training. Inter-observer agreement (k-value) of WLI alone and combined WLI and M-NBI for the experienced and inexperienced endoscopists also improved from 0.61, 0.61, and 0.61, 0.53 to 0.68, 0.71, and 0.71, 0.59, respectively. Multivariate analysis revealed that the educational course but not experience in endoscopy, NBI, or magnification significantly improved the diagnostic accuracy. M-NBI had a significant additional benefit to WLI, with an improvement in accuracy from 36% to 56% for the cases with m3/sm1 cancers (P < 0.05). Conclusions: A well-designed training program can improve the diagnostic accuracy in evaluating cancer invasion depth, with substantial agreement.

AB - Background and Aim: Optimal staging of the invasion depth of superficial esophageal squamous cell carcinoma is vital before endoscopic treatment. A new simplified magnified narrow-band imaging (M-NBI) classification system based on vascular architecture has recently been developed by the Japan Esophageal Society; however, its validity remains uncertain. Methods: A total of 11 experienced and 11 inexperienced endoscopists were invited to join an endoscopic training program, which was composed of pretest, educational section, and post-test. The pretest and post-test sections included a set of endoscopic photos from 40 subjects with superficial esophageal squamous cell carcinoma with various invasion depths. Each subject appeared twice in the test, one with white-light imaging (WLI) only and the other with both WLI and M-NBI. The educational section included lectures and video demonstrations. Results: The accuracy of WLI alone and combined with M-NBI at baseline were 0.53, 0.57 and 0.43, 0.41 for the experienced and inexperienced endoscopists, respectively, which then improved to 0.57, 0.63 and 0.49, 0.52 after training. Inter-observer agreement (k-value) of WLI alone and combined WLI and M-NBI for the experienced and inexperienced endoscopists also improved from 0.61, 0.61, and 0.61, 0.53 to 0.68, 0.71, and 0.71, 0.59, respectively. Multivariate analysis revealed that the educational course but not experience in endoscopy, NBI, or magnification significantly improved the diagnostic accuracy. M-NBI had a significant additional benefit to WLI, with an improvement in accuracy from 36% to 56% for the cases with m3/sm1 cancers (P < 0.05). Conclusions: A well-designed training program can improve the diagnostic accuracy in evaluating cancer invasion depth, with substantial agreement.

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