Result: Can optical evaluation distinguish between T1a and T1b esophageal adenocarcinoma: an international expert interobserver agreement study.
Original Publication: Stuttgart, Thieme.
Local Abstract: [Publisher, German] Piecemeal endoscopic mucosal resection (EMR) is an acceptable technique for T1a esophageal adenocarcinoma, but en bloc R0 excision is advocated for T1b disease as it may offer a potential cure and mitigate recurrence. Thus, distinguishing between T1a and T1b disease is imperative under current treatment paradigms. We investigated whether expert Barrett’s endoscopists could make this distinction based on optical evaluation. [Publisher, German] Endoscopic images of histologically confirmed high grade dysplasia (HGD), T1a, and T1b disease (20 sets for each) were compiled from consecutive patients at a single institution. Each set contained four images including an overview, a close-up in high definition white light, a near-focus magnification image, and a narrow-band image. Experts predicted the histology for each set. [Publisher, German] 19 experts from 8 countries (Australia, USA, Italy, Netherlands, Germany, Canada, Belgium, and Portugal) participated. The majority had been practicing for > 20 years, with a median (interquartile range) annual case volume of 50 (18–75) for Barrett’s EMR and 25 (10–45) for Barrett’s endoscopic submucosal dissection. Esophageal adenocarcinoma (T1a/b) could be distinguished from HGD with a pooled sensitivity of 89.1 % (95 %CI 84.7–93.4). T1b adenocarcinoma could be predicted with a pooled sensitivity of 43.8 % (95 %CI 29.9–57.7). Fleiss’ kappa was 0.421 (95 %CI 0.399–0.442; P < 0.001), indicating fair-to-moderate agreement. [Publisher, German] Expert Barrett’s endoscopists could reliably differentiate T1a/T1b esophageal adenocarcinoma from HGD. Despite fair-to-moderate agreement for T staging, T1b disease could not be reliably distinguished from T1a disease. This may impact clinical decision making and selection of endoscopic techniques.
Further information
Background: Piecemeal endoscopic mucosal resection (EMR) is an acceptable technique for T1a esophageal adenocarcinoma, but en bloc R0 excision is advocated for T1b disease as it may offer a potential cure and mitigate recurrence. Thus, distinguishing between T1a and T1b disease is imperative under current treatment paradigms. We investigated whether expert Barrett's endoscopists could make this distinction based on optical evaluation.
Methods: Endoscopic images of histologically confirmed high grade dysplasia (HGD), T1a, and T1b disease (20 sets for each) were compiled from consecutive patients at a single institution. Each set contained four images including an overview, a close-up in high definition white light, a near-focus magnification image, and a narrow-band image. Experts predicted the histology for each set.
Results: 19 experts from 8 countries (Australia, USA, Italy, Netherlands, Germany, Canada, Belgium, and Portugal) participated. The majority had been practicing for > 20 years, with a median (interquartile range) annual case volume of 50 (18-75) for Barrett's EMR and 25 (10-45) for Barrett's endoscopic submucosal dissection. Esophageal adenocarcinoma (T1a/b) could be distinguished from HGD with a pooled sensitivity of 89.1 % (95 %CI 84.7-93.4). T1b adenocarcinoma could be predicted with a pooled sensitivity of 43.8 % (95 %CI 29.9-57.7). Fleiss' kappa was 0.421 (95 %CI 0.399-0.442; P < 0.001), indicating fair-to-moderate agreement.
Conclusions: Expert Barrett's endoscopists could reliably differentiate T1a/T1b esophageal adenocarcinoma from HGD. Despite fair-to-moderate agreement for T staging, T1b disease could not be reliably distinguished from T1a disease. This may impact clinical decision making and selection of endoscopic techniques.
(Thieme. All rights reserved.)
N. Shahidi has received speaker honoraria from Boston Scientific and Pharmascience. M.B. Wallace is a consultant for Fujifilm, Boston Scientific, Endiatix, Verily, Medtronic, and InterVenn Biosciences. A. Repici has received research support from Fujifilm, Boston Scientific Corporation, and Norgine. M. Dinis-Ribeiro is a consultant for Medtronic and Roche. G.B. Haber is a consultant for Olympus and Ovesco. I. Waxman is a consultant for Medtronic, BSCI, and Cook Medical. P.D. Siersema has received research grants from MOTUS GI, Norgine, and Pentax. R. Pouw is a consultant for Medtronic BV and MicroTech Europe. A. Lemmers is a consultant for Cook, and has received research support from Boston Scientific. J.D. Mosko has received speaker/consulting fees from Boston Scientific, Pendopharm, Medtronic, and Fuji. C. Teshima has received speaker/consulting fees from Boston Scientific, consultant fees from Olympus, and speaker fees from Medtronic. K. Ragunath has received research support and grants from Olympus. T. Rösch has received advisory fees for Olympus, lecture honoraria from Falk and AbbVie, and research support from Olympus, Erbe, Fujifilm, and Microtech. O. Pech has received honoraria from Medtronic, Boston Scientific, Fujifilm, and Olympus. T. Beyna is a consultant for Olympus, Boston Scientific, MicroTech Endoscopy, and Fractyl. P. Sharma is a consultant for Boston Scientific and Olympus, and has received grant support from US Endoscopy, Medtronic, Fujifilm, Ironwood, Cosmo Pharmaceuticals, and Erbe. M.J. Bourke has received research support from Olympus, Cook Medical, and Boston Scientific. S. Gupta, F. Vito Mandarino, L. Hourigan, H. Messmann, A. Taylor, R. Bisschops, E.Y.T. Lee, and N.G. Burgess declare that they have no conflict of interest.