Confocal Laser Endomicroscopy Interpretation and Differentiation of Pancreatic Cysts: A Randomized Trial of Teaching Modalities

Autor: Arsheya Patel, Srikanth Vedachalam, Kenneth D. Allen, Jennifer Behzadi, Anand Patel, Megan Q. Chan, Mitchell L. Ramsey, Sheryl Pfeil, Anjuli K. Luthra, Hisham Hussan, J. Royce Groce, Dana Lee, Alecia Blaszczak, Sagar Patel, Filsan Farah, Somashekar G. Krishna, Peter P. Stanich, Emmanuel Ugbarugba, Sebastian Strobel, Antoinette Pusateri, Kyle Porter
Rok vydání: 2021
Předmět:
Zdroj: Techniques and Innovations in Gastrointestinal Endoscopy. 23:8-17
ISSN: 2590-0307
Popis: Background EUS-guided needle-based confocal laser endomicroscopy (nCLE) has not been widely adopted for the differentiation of pancreatic cystic lesions (PCLs), perhaps due to a perceived difficulty in learning novel CLE image patterns. Hence, we sought to investigate the optimal teaching modality for interpretation of nCLE imaging from PCLs. Methods Sixteen nCLE-naive observers blinded to clinical data were randomized into didactic (classroom-based) versus self-directed (computer-based) teaching groups to review nCLE videos and differentiate mucinous and non-mucinous PCLs. The study was conducted concurrently for both groups in 3 phases. Phase-1-Teaching: both groups received an overview of EUS-nCLE of PCLs. Phase-2-Training: assessment of 20 EUS-nCLE subject-videos; the didactic group had a feedback session with an nCLE expert while the self-directed group received this information via pre-recorded presentation. Phase-3-Testing: assessment of 50 EUS-nCLE subject-videos. Results For all observers (n = 16), the diagnostic accuracy for nCLE-based differentiation of mucinous from non-mucinous PCLs was higher (p=0.005) in the Phase-3-Testing (94.6%, 95%CI: 92-96%) than in Phase-2-Training (89.9%, 95%CI: 85-93%). During Phase-3-Testing, both the didactic and self-directed teaching groups achieved a comparable (p=0.48) diagnostic accuracy of 93.9% and 95.4%, respectively. The interobserver agreement (kappa, standard error) for the differentiation of mucinous from non-mucinous PCLs improved from Phase-2-Training to Phase-3-Testing stage, and was “substantial” for both the didactic (k=0.81, 0.03) and self-directed (k=0.79, 0.03) training groups. Conclusion Notwithstanding didactic and self-directed teaching, a ‘training’ and ‘test’ strategy accomplished high diagnostic accuracies and considerable interobserver agreement among naive observers for EUS-nCLE image differentiation of PCLs; Clinical trial NCT02516488 ( https://clinicaltrials.gov/ct2/show/NCT02516488 )
Databáze: OpenAIRE
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