虽然对 T1a 食管腺癌进行分段内镜粘膜切除术 (EMR) 是可以接受的，但对于 T1b 疾病则提倡采用整块 R0 切除术，因为它可能提供潜在的治愈方法并减轻复发。因此，在当前的治疗模式下，区分 T1a 和 T1b 疾病势在必行。我们试图确定 Barrett 内窥镜专家是否能够根据光学评估做出这种区分。从连续患者中收集了 60 组经组织学证实的高度不典型增生 (HGD)、T1a 和 T1b 疾病（每组 n=20）的内窥镜图像在一个机构。每组包含四张图像，并经过标准化处理，包括概览、高清白光特写、近焦放大图像和窄带图像。每组均邀请专家进行组织学预测。来自澳大利亚、美国、意大利、荷兰、德国、加拿大、比利时、葡萄牙等8个国家的19名专家参加。大多数人的执业时间超过 20 年，Barrett 的 EMR 病例数中位数为 50 例（IQR 18-75），Barrett 的 ESD 病例数为 25 例（IQR 10-45）。食管腺癌 (T1a/b) 可以与 HGD 区分开来，汇总敏感性为 89.1% (95% CI:84.7-93.4)。在预测 T1b 腺癌病例的 T 分期时，汇总敏感性为 43.8% (95% CI:29.9) Fleiss 的 kappa 为 0.421（95% CI：0.399-0.442，P<0.001），表明中等至中等的一致性。专家 Barrett 的内窥镜医师可以可靠地区分 T1a/T1b 食管腺癌和 HGD。 T 分期的一致性，T1b 疾病与 T1a 疾病无法可靠区分，这可能会对临床决策和内镜治疗方法的选择产生影响。Thieme 保留所有权利。

While piecemeal endoscopic mucosal resection (EMR) for T1a oesophageal adenocarcinoma is acceptable, enbloc-R0 excision is advocated for T1b disease as it may offer a potential cure and mitigate recurrence. Thus, distinguishing between T1a and T1b disease is imperative under current treatment paradigms. We sought to ascertain whether expert Barrett's endoscopists were able to make this distinction based on optical evaluation.Sixty sets of endoscopic images of histologically confirmed high grade dysplasia (HGD), T1a and T1b disease (n=20 for each) were compiled from consecutive patients at a single institution. Each set contained four images, and were standardized to include an overview, a close-up in high-definition white light, a near-focus magnification image, and a narrow-band image. Experts were invited to predict histology for each set.19 experts from 8 countries (Australia, USA, Italy, Netherlands, Germany, Canada, Belgium, and Portugal) participated. The majority had been practicing for >20 years, with a median annual case volume for Barrett's EMR of 50 (IQR 18-75), and Barrett's ESD of 25 (IQR 10-45). Oesophageal adenocarcinoma (T1a/b) could be distinguished from HGD, with a pooled sensitivity of 89.1% (95% CI:84.7-93.4. When predicting T-stage for T1b adenocarcinoma cases, pooled sensitivity was 43.8% (95% CI:29.9-57.7). Fleiss' kappa was 0.421 (95% CI:0.399-0.442, P<0.001), indicating fair-to-moderate agreement.Expert Barrett's endoscopists can reliably differentiate T1a/T1b oesophageal adenocarcinoma from HGD. Although there is fair-to-moderate agreement for T-staging, T1b disease cannot be reliably distinguished from T1a disease. This may have implications on clinical decision making and selection of endoscopic treatment methods.Thieme. All rights reserved.