Exploration of an effective training system for diagnosis of superficial esophageal squamous cell carcinoma with magnifying narrow-band imaging: Prospective research

Background and aims: The aim was to explore an effective training system for diagnosis of superficial esophageal squamous cell carcinoma (SESCC) and its staging with magnifying narrow-band imaging (M-NBI).

Patients and methods: Fifteen endoscopists with no or less M-NBI experience participated in this training, which consisted of four stages and five teaching methods (M-NBI classification criterion, case analysis, hands-on operation, error correction and SESCC pathological knowledge). M-NBI images were evaluated and diagnostic accuracy was analyzed.

Results: After training, the accuracy of distinguishing neoplastic esophageal from non-neoplastic (0.58 ± 0.16 vs. 0.95 ± 0.05, P = 0.000) and diagnosing SESCC staging (0.25 ± 0.26 vs. 0.89 ± 0.08, P = 0.000) with M-NBI were significantly increased. Participants with no M-NBI experience achieve equivalent diagnostic accuracy with less experienced trainees after the training (0.91 ± 0.08 vs. 0.92 ± 0.04, P = 0.816). Besides, diagnosis of MM (muscularis mucosa)/SM1 (submucosal) staging tumors (Stage I, 0.47 ± 0.15; Stage II-III-IV, 0.76 ± 0.12) with M-NBI was difficult for trainees and should be the focus of this training. Every teaching method could improve the diagnostic accuracy for esophageal lesions, especially for case analysis (from 0.59 ± 0.10 to 0.85 ± 0.08, P = 0.000). In addition, the average operation score for trainees was significantly increased after hands-on teaching (60.40 ± 11.11 vs. 91.80 ± 4.28, P = 0.0001).

Conclusions: For novices, this training system showed efficient performance for diagnosing SESCC staging with M-NBI. Diagnosing MM/SM1 staging SESCC was difficult for beginners, and should be the focus of training.