Reliability of Paris Classification for superficial neoplastic gastric lesions improves with training and narrow band imaging

Author:

Ribeiro Helena1,Libânio Diogo2,Castro Rui2,Ferreira Anibal3,Barreiro Pedro4,Boal Carvalho Pedro5,Capela Tiago4,Pimentel-Nunes Pedro267,Santos Cristina7,Dinis-Ribeiro Mário27

Affiliation:

1. Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal

2. Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

3. Gastroenterology Department, Hospital of Braga, Braga, Portugal

4. Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal

5. Gastroenterology Department, Senhora da Oliveira Hospital, Guimarães, Portugal

6. Department of Surgery and Physiology, Porto Faculty of Medicine, Porto, Portugal

7. MEDCIDS/Porto Faculty of Medicine, Porto, Portugal

Abstract

Abstract Background and study aims Paris Classification is used to classify gastrointestinal superficial neoplastic lesions and to predict presence of submucosal invasion. We aimed to evaluate interobserver reliability and agreement for this classification among Western endoscopists. Methods A total of 54 superficial gastric lesions were independently classified according to Paris classification by eight endoscopists (4 experts and 4 non-experts). Observers were asked to classify two sets of images – first, obtained with high-resolution white light (HR-WL) endoscopy and secondly, with the same HR-WL images paired with images obtained with high-resolution Narrow Band Imaging (HR-NBI) – HR-WL + NBI image group. Results Overall interobserver reliability when asked to classify in I, II or III was good both using HR-WL images and HR-WL + NBI images (wK of 0.65 and 0.70, respectively). The proportion of agreement for type III lesions was 0.48 for HR-WL images increasing to 0.74 in the HR-WL + NBI group. Interobserver reliability for identification of a IIc component was only moderate (wK 0,47). NBI improves both sensitivity and interobserver reliability among trainees (from wK 0.19 to 0.47). Specificity was higher than sensitivity in predicting submucosal invasion. Conclusion Overall, the reliability of Paris classification is moderate to good. Training on this classification or its revision and use of technology such as NBI may improve not only reliability and agreement but also accuracy.

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology,Medicine (miscellaneous)

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