Diagnostic performance of volumetric laser endomicroscopy for Barrett's esophagus dysplasia amongst gastroenterology trainees

BACKGROUND

Volumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett's esophagus (BE) surveillance. VLE image interpretation is challenged by subtle grayscale image variation across a large amount of data. Training in VLE interpretation is not standardized. This study aims to determine if VLE training can be incorporated into a gastroenterology (GI) fellowship curriculum with the use of a self-directed module.

METHODS

A standardized, self-directed training module (30 min) was created explaining the background and established VLE criteria for the diagnosis of BE dysplasia. A VLE image dataset was generated from a multicenter VLE database of targeted biopsies. GI trainees were asked to grade each image for the presence or absence of the following criteria (I) increased surface optical frequency domain imaging (OFDI) signal intensity and (II) atypical glands and provide a final diagnosis (dysplastic vs. non-dysplastic). Diagnostic performance was calculated and results compared to VLE expert interpretation using histology as the gold-standard.

RESULTS

The dataset included 50 VLE images (10 high-grade dysplasia, 40 non-dysplastic BE). VLE images were reviewed in a randomized and blinded fashion by 5 GI trainees with no prior VLE experience and 5 experienced VLE users. Sensitivity, specificity and accuracy of GI trainees was 83.3% (95% CI: 71.5-91.7%), 59.0% (95% CI: 51.6-66.0%), and 64.8% (95% CI: 58.5-70.7%) compared to 80.0% (95% CI: 67.7-89.2%), 79.5% (95% CI: 73.0-85.0%), and 79.6% (95% CI: 74.1-84.4%) for VLE experts respectively. The difference in specificity and accuracy between the two groups were statistically significant with P<0.001.

CONCLUSIONS

A brief training session on VLE is inadequate to reach competency in interpretation of VLE by GI trainees. Additional experience is required to accurately interpret VLE images.

The flexible migratory orientation system of the savannah sparrow (Passerculus sandwichensis)

The orientation system of the Savannah sparrow (Passerculus sandwichensis) is typical of nocturnal migrant passerine birds. It is based on a system of interacting compass senses: magnetic, star, polarized light and, perhaps, sun compasses. The magnetic compass capability develops in birds that have never seen the sky, but the preferred direction of magnetic orientation may be calibrated by celestial rotation (stars at night and polarized skylight patterns during the day). This ability to recalibrate magnetic orientation persists throughout life and enables the bird to compensate for variability in magnetic declination that may be encountered as it migrates. The polarized light compass may be manipulated by exposing young birds to altered patterns of skylight polarization. There is some evidence that the magnetic field may be involved in calibration of the polarized light compass. In short-term orientation decision-making during migration, visual information at sunset overrides both stars and magnetic cues, and polarized skylight is the relevant stimulus in dusk orientation. The star pattern compass seems to be of little importance. This extremely flexible orientation system enables the birds to respond to spatial and temporal variability in the quality and availability of orientation information.