Improvement of detection sensitivity of upper gastrointestinal epithelial neoplasia in linked color imaging based on data of eye tracking

Abstract

Background and Aim Linked color imaging (LCI) is useful for screening in the gastrointestinal tract; however, its true clinical benefit has not been determined. The aim of this study was to determine the objective advantage of LCI for detection of upper gastrointestinal neoplasms. Methods Nine endoscopists, including three novices, three trainees, and three experts, prospectively performed eye tracking. From 30 cases of esophageal or gastric neoplasm and 30 normal cases without neoplasms, a total of 120 images, including 60 pair images of white light imaging (WLI) and LCI taken at the same positions and angles, were randomly shown for 10 s. The sensitivity of tumor detection as a primary endpoint was evaluated and sensitivities by organ, size, and visual gaze pattern were also assessed. Color differences (ΔE using CIE1976 [L*a*b*]) between lesions and surrounding mucosa were measured and compared with detectability. Results A total of 1080 experiments were completed. The sensitivities of tumor detection in WLI and LCI were 53.7% (50.1–56.8%) and 68.1% (64.8–70.8%), respectively (P = 0.002). LCI provided higher sensitivity than WLI for the novice and trainee groups (novice: 42.2% [WLI] vs 65.6% [LCI], P = 0.003; trainee: 54.4% vs 70.0%, P = 0.045). No significant correlations were found between sensitivity and visual gaze patterns. LCI significantly increased ΔE, and the diagnostic accuracy with WLI depended on ΔE. Conclusions In conclusion, LCI significantly improved sensitivity in the detection of epithelial neoplasia and enabled epithelial neoplasia detection that is not possible with the small color difference in WLI. (UMIN000047944).

Shedding a new light on gastric cancer screening

“…Although the authors of this study report that the main advantage of OE-2 is to increase brightness, we should note that new generation IEE technologies (BLI-bright, NBI-bright, LCI) also have a brighter image when compared with the first version of these technologies, and that the use of other new IEE technologies have been shown to also increase detection rates. [10][11][12] Another important message of these study is that the benefit was greater in patients with a background of chronic atrophic gastritis. Although a technology that increases detection should probably be also used in low-risk cases, these results reinforce the importance of performing a high-quality endoscopy with virtual chromoendoscopy in the surveillance of patients with known precancerous conditions, as recommended in ESGE guidelines.…”

“…Although the authors of this study report that the main advantage of OE‐2 is to increase brightness, we should note that new generation IEE technologies (BLI‐bright, NBI‐bright, LCI) also have a brighter image when compared with the first version of these technologies, and that the use of other new IEE technologies have been shown to also increase detection rates. 10 , 11 , 12 …”