Endoscopy
DOI: 10.1055/a-2399-1401
Original article

Can optical evaluation distinguish between t1a and t1b esophageal adenocarcinoma: an international expert inter-observer agreement study

1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Luke F Hourigan
3   Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia (Ringgold ID: RIN1966)
,
Helmut Messmann
4   Department of Gastroenterology and Infectious Diseases, University Hospital, Augsburg, Germany
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5   Gastroenterology, Mayo Clinic, Jacksonville, United States
,
Alessandro Repici
6   Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
,
Mario Dinis-Ribeiro
7   Gastroenterology, Francisco Gentil Portuguese Institute for Oncology of Porto, Porto, Portugal (Ringgold ID: RIN59035)
,
Gregory B Haber
8   Division of Gastroenterology, NYU Langone Health, New York, United States
,
Andrew C F Taylor
9   Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Australia
,
Irving Waxman
10   Department of Gastroenterology, Rush University Medical Center, Chicago, United States
,
Peter D. Siersema
11   Dept. of Gastroenterology and Hepatology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Roos E. Pouw
12   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
,
Arnaud Lemmers
13   Gastroenterology, Hepatopancreatology and Digestive Oncology, Hopital Erasme, Bruxelles, Belgium (Ringgold ID: RIN70496)
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14   Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
,
Jeffrey D Mosko
15   Department of Therapeutic Endoscopy, St Michael's Hospital, Toronto, Canada (Ringgold ID: RIN10071)
,
Christopher Teshima
15   Department of Therapeutic Endoscopy, St Michael's Hospital, Toronto, Canada (Ringgold ID: RIN10071)
,
Krish Ragunath
16   Curtin Medical School, Curtin University Curtin Medical School, Perth, Australia (Ringgold ID: RIN614117)
17   Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia (Ringgold ID: RIN6508)
,
Thomas Rösch
18   Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Oliver Pech
19   Department of Gastroenterology and interventional Endoscopy, St. John of God Hospital, Teaching Hospital of the University of Regensburg, Regensburg, Germany
,
20   Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
Prateek Sharma
21   Gastroenterology, University of Kansas School of Medicine and VA Medical Center, Kansas City, United States
,
Eric Y Lee
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Michael J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
› Author Affiliations

Introduction: While piecemeal endoscopic mucosal resection (EMR) for T1a oesophageal adenocarcinoma is acceptable, enbloc-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 sought to ascertain whether expert Barrett’s endoscopists were able to make this distinction based on optical evaluation. Methods: Sixty sets of endoscopic images of histologically confirmed high grade dysplasia (HGD), T1a and T1b disease (n=20 for each) were compiled from consecutive patients at a single institution. Each set contained four images, and were standardized to include an overview, a close-up in high-definition white light, a near-focus magnification image, and a narrow-band image. Experts were invited to predict 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 annual case volume for Barrett’s EMR of 50 (IQR 18-75), and Barrett’s ESD of 25 (IQR 10-45). Oesophageal adenocarcinoma (T1a/b) could be distinguished from HGD, with a pooled sensitivity of 89.1% (95% CI:84.7-93.4. When predicting T-stage for T1b adenocarcinoma cases, pooled sensitivity was 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 can reliably differentiate T1a/T1b oesophageal adenocarcinoma from HGD. Although there is fair-to-moderate agreement for T-staging, T1b disease cannot be reliably distinguished from T1a disease. This may have implications on clinical decision making and selection of endoscopic treatment methods.



Publication History

Received: 08 June 2024

Accepted after revision: 21 August 2024

Accepted Manuscript online:
21 August 2024

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