| Background:Treatment strategies selection depends on accurate T stage diagnosis and the ability of determining the depth of early gastric cancer(EGC)is very important to endoscopists.The depth-predicting score(DPS)was proposed based on conventional white-light imaging(C-WLI)endoscopic features of EGC to determine the invasion depth of the neoplasm.However,the effect of DPS on training endoscopists remains unclear.Therefore,we aimed to investigate the effect of short-term DPS training on improving the diagnostic ability of EGC invasion depth and compare the training effect among non-expert endoscopists at different levels.Methods:The dataset of the diagnostic test comprised C-WLI endoscopic images of 88 cases of histologically proven differentiated EGC with complete medical record materials.According to the inclusion and exclusion criteria,a total of 16 participants were enrolled and completed the training.Participants were divided into a trainee group and a junior endoscopist group according to the total number of C-WLI endoscopies performed.In the training session,all participants were asked to take the diagnostic test by the test dataset first before the training.One week after,the definitions and scoring rules of DPS were instructed,and classic C-WLI endoscopic example graphics were exhibited to the participants.Subsequently,all participants took the second diagnostic test by the same test dataset immediately after training.Using the histological invasion depth as gold standard,the diagnostic accuracy rate,specificity and sensitivity of invasion depth were calculated differently before the training and after the completion of training.Results:1.The total number of C-WLI endoscopies performed showed a significant difference between the trainee group and junior endoscopist group(350 vs.2500,P = 0.001).2.The overall diagnostic accuracy of invasion depth was improved significantly after completing DPS training compared with before(68.75±5.71% vs.61.58±9.61%,P =0.009).In the subgroup analysis,the post-training accuracy was both higher than the pre-training accuracy in the trainee group(68.32±5.71% vs 61.65±7.33%)and junior endoscopist group(69.18±6.06% vs 61.51±12.0%),but significant improvement was observed only in the trainee group(P = 0.034).No significant difference between the trainee group and junior endoscopist group was observed for pre-training accuracy(P =0.978).In addition,no significant difference in post-training accuracy between the two groups was observed(P = 0.776).3.The pathological diagnosis of SM2 EGC was taken as a positive result.The overall diagnostic specificity of invasion depth was improved significantly after completing DPS training compared with before(73.11±10.47% vs 61.08±14.48%,P = 0.007).In the subgroup analysis,the post-training specificity was higher than the pre-training specificity,but significant improvement was not observed in the trainee group(72.54±11.89% vs 62.12±9.92%,P = 0.070)and junior endoscopist group(73.68±9.65% vs 60.04±16.99%,P = 0.067).No significant difference between the trainee group and junior endoscopist group was observed for pre-training specificity(P=0.769).In addition,no significant difference in post-training specificity between the two groups was observed(P = 0.837).4.The pathological diagnosis of SM2 EGC was taken as a positive result.The overall diagnostic sensitivity of invasion depth was decreased after completing DPS training compared with before(55.40±14.20% vs 63.07±8.44%,P = 0.139).In the subgroup analysis,the post-training sensitivity was lower than pre-training sensitivity in the trainee group(55.11±17.59% vs 60.22±10.24%,P = 0.540)and junior endoscopist group(55.68±11.07% vs 65.91±5.43%,P = 0.035).No significant difference between the trainee group and junior endoscopist group was observed for pre-training sensitivity(P = 0.194).In addition,no significant difference in post-training sensitivity between the two groups was observed(P = 0.939).Conclusion:Short-term DPS training can improve the diagnostic ability of the invasion depth of EGC,and homogenize the diagnostic ability of non-expert endoscopists at different levels.The detection rate of mucosal(M)and upper submucosal(SM1)EGC could been improved.The sensitivity of DPS for the diagnosis of deeper submucosa(SM2)EGC was low.In addition,DPS offers the advantages of convenience,simplicity,low cost,and no additional equipment,providing a convenient and effective method for endoscopists training. |
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