Pre- and post-training session evaluation for interobserver agreement and diagnostic accuracy of probe-based confocal laser endomicroscopy for biliary strictures

2013 ◽  
Vol 26 (4) ◽  
pp. 577-580 ◽  
Author(s):  
Jayant P. Talreja ◽  
Brian G. Turner ◽  
Frank G. Gress ◽  
Sammy Ho ◽  
Savreet Sarkaria ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Interobserver Agreement ◽  
Training Session ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Session Evaluation

scholarly journals Probe-Based Confocal Laser Endomicroscopy for Indeterminate Biliary Strictures: Refinement of the Image Interpretation Classification

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Michel Kahaleh ◽  
Marc Giovannini ◽  
Priya Jamidar ◽  
S. Ian Gan ◽  
Paola Cesaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Interobserver Agreement ◽  
Image Interpretation ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Inflammatory Conditions ◽  
Paris Classification ◽  
Low Sensitivity ◽  
Duct Stricture

Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives.Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences.Results. Overall accuracy was 82.5% (n=40retrospectively diagnosed) versus 81% (n=89prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k=0.37).Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.

Interpretation of Probe-Based Confocal Laser Endomicroscopy of Indeterminate Biliary Strictures: Is There Any Interobserver Agreement?

2012 ◽  
Vol 57 (12) ◽  
pp. 3299-3302 ◽  
Author(s):  
Jayant P. Talreja ◽  
Amrita Sethi ◽  
Priya A. Jamidar ◽  
Satish K. Singh ◽  
Richard S. Kwon ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures

385 Interobserver Agreement in the Interpretation of Probe-Based Confocal Laser Endomicroscopy of Indeterminate Biliary Strictures: A Multi-Center Comparison

2011 ◽  
Vol 73 (4) ◽  
pp. AB126 ◽  
Author(s):  
Jayant P. Talreja ◽  
Amrita Sethi ◽  
Priya A. Jamidar ◽  
Satish K. Singh ◽  
Richard S. Kwon ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures

scholarly journals Deep learning systems detect dysplasia with human-like accuracy using histopathology and probe-based confocal laser endomicroscopy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shan Guleria ◽  
Tilak U. Shah ◽  
J. Vincent Pulido ◽  
Matthew Fasullo ◽  
Lubaina Ehsan ◽  
...  
Keyword(s):  
Deep Learning ◽  
Diagnostic Accuracy ◽  
High Sensitivity ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Learning Approaches ◽  
Learning Models ◽  
Whole Slide Image ◽  
Slide Image ◽  
Level Model

AbstractProbe-based confocal laser endomicroscopy (pCLE) allows for real-time diagnosis of dysplasia and cancer in Barrett’s esophagus (BE) but is limited by low sensitivity. Even the gold standard of histopathology is hindered by poor agreement between pathologists. We deployed deep-learning-based image and video analysis in order to improve diagnostic accuracy of pCLE videos and biopsy images. Blinded experts categorized biopsies and pCLE videos as squamous, non-dysplastic BE, or dysplasia/cancer, and deep learning models were trained to classify the data into these three categories. Biopsy classification was conducted using two distinct approaches—a patch-level model and a whole-slide-image-level model. Gradient-weighted class activation maps (Grad-CAMs) were extracted from pCLE and biopsy models in order to determine tissue structures deemed relevant by the models. 1970 pCLE videos, 897,931 biopsy patches, and 387 whole-slide images were used to train, test, and validate the models. In pCLE analysis, models achieved a high sensitivity for dysplasia (71%) and an overall accuracy of 90% for all classes. For biopsies at the patch level, the model achieved a sensitivity of 72% for dysplasia and an overall accuracy of 90%. The whole-slide-image-level model achieved a sensitivity of 90% for dysplasia and 94% overall accuracy. Grad-CAMs for all models showed activation in medically relevant tissue regions. Our deep learning models achieved high diagnostic accuracy for both pCLE-based and histopathologic diagnosis of esophageal dysplasia and its precursors, similar to human accuracy in prior studies. These machine learning approaches may improve accuracy and efficiency of current screening protocols.

scholarly journals Probe-based confocal laser endomicroscopy and Barrett's esophagus – just a scientific toy or significant improvement in diagnosis?

2021 ◽  
Author(s):  
Luka Vranić ◽  
Tin Nadarević ◽  
Davor Štimac
Keyword(s):  
Diagnostic Accuracy ◽  
Real Time ◽  
Barrett’S Esophagus ◽  
Predictive Value ◽  
Barrett's Esophagus ◽  
High Reliability ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Imaging Method ◽  
Increased Risk

Background: Barrett’s esophagus (BE) requires surveillance to identify potential neoplasia at early stage. Standard surveillance regimen includes random four-quadrant biopsies by Seattle protocol. Main limitations of random biopsies are high risk of sampling error, difficulties in histology interpretation, common inadequate classification of pathohistological changes, increased risk of bleeding and time necessary to acquire the final diagnosis. Probe-based confocal laser endomicroscopy (pCLE) has emerged as a potential tool with an aim to overcome these obvious limitations. Summary: pCLE represents real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patient. The main advantages would be real-time diagnosis and decision making, greater diagnostic accuracy and to evaluate larger area compared to random biopsies. Clinical pCLE studies in esophagus show high diagnostic accuracy and its high negative predictive value offers high reliability and confidence to exclude dysplastic and neoplastic lesions. However, it still cannot replace histopathology due to lower positive predictive value and sensitivity. Key messages: Despite promising results, its role in routine use in patients with Barrett’s esophagus remains questionable primarily due to lack of well-organized double-blind randomized trials.

scholarly journals Emerging Technologies for the Diagnosis of Perihilar Cholangiocarcinoma

2018 ◽  
Vol 38 (02) ◽  
pp. 160-169 ◽  
Author(s):  
Sumera Rizvi ◽  
John Eaton ◽  
Ju Dong Yang ◽  
Vinay Chandrasekhara ◽  
Gregory Gores
Keyword(s):  
Emerging Technologies ◽  
High Specificity ◽  
Biliary Tree ◽  
Extracellular Vesicle ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Conventional Cytology ◽  
Special Expertise

AbstractThe diagnosis of malignant biliary strictures remains problematic, especially in the perihilar region and in primary sclerosing cholangitis (PSC). Conventional cytology obtained during endoscopic retrograde cholangiography (ERC)-guided brushings of biliary strictures is suboptimal due to limited sensitivity, albeit it remains the gold standard with a high specificity. Emerging technologies are being developed and validated to address this pressing unmet patient need. Such technologies include enhanced visualization of the biliary tree by cholangioscopy, intraductal ultrasound, and confocal laser endomicroscopy. Conventional cytology can be aided by employing complementary and advanced cytologic techniques such as fluorescent in situ hybridization (FISH), and this technique should be widely adapted. Interrogation of bile and serum by examining extracellular vesicle number and cargo, and exploiting next-generation sequencing and proteomic technologies, is also being explored. Examination of circulating cell-free deoxyribonucleic acid (cfDNA) for differentially methylated regions is a promising test which is being rigorously validated. The special expertise required for these analyses has to date hampered their validation and adaptation. Herein, we will review these emerging technologies to inform the reader of the progress made and encourage further studies, as well as adaptation of validated approaches.

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