Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia

Fukuda, Hisashi; Mıura, Yoshimasa; Osawa, Hiroyuki; Takezawa, Takahito; Ino, Yuji; Okada, Masahiro; Khurelbaatar, Tsevelnorov; Lefor, Alan Kawarai; Yamamoto, Hironori

doi:10.1007/s00535-018-1515-6

Cited by 64 publications

(92 citation statements)

References 30 publications

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“…In addition, previous studies showed that LCI depicted gastric intestinal metaplasia as purple or lavender. 23,33 In our study, even for EGC with normal color, the LCI visibility scores and CD values were significantly higher than those with WLI. With respect to the grade of ELA, LCI particularly improved the visibility of lesions with high ELA.…”

Section: Discussioncontrasting

confidence: 49%

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Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white‐light imaging versus linked color imaging

Kitagawa

Suzuki

Nankinzan

et al. 2019

Digestive Endoscopy

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Background and Aim We aimed to investigate whether linked color imaging (LCI) improves endoscopic visibility of early gastric cancers (EGC) after Helicobacter pylori eradication, which are often difficult to detect, and reduces the miss rate when compared with white‐light imaging (WLI). Methods The visibility study used two images, one each with WLI and LCI, from 84 consecutive EGC after H. pylori eradication. Endoscopic visibility was evaluated using a visibility score and color difference (CD) value. To analyze miss rates, we studied a library of recorded videos using both WLI and LCI for 70 other consecutive patients after H. pylori eradication, among whom 19 had EGC. Endoscopic screening was done using the same protocol to map the entire stomach. Six endoscopists reviewed the videos in a randomized order. Miss rates of EGC were compared among the modalities. Results Mean [(±standard deviation) visibility scores with LCI were significantly higher than those with WLI (3.19 ± 0.84 vs 2.52 ± 0.98, P < 0.001), as were mean CD values (26.3 ± 9.1 vs 13.6 ± 6.3, P < 0.001). Miss rates of the six endoscopists were significantly lower with LCI than with WLI (30.7% vs 64.9%, P < 0.001). Both expert and trainee endoscopists had significantly better results with LCI than with WLI. Conclusions Linked color imaging significantly improved the visibility of EGC after H. pylori eradication compared with WLI using both subjective and objective criteria. Furthermore, LCI significantly reduced miss rates of these lesions compared with WLI.

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Section: Discussioncontrasting

confidence: 49%

“…[14][15][16][17][18][19] LCI improve the visibility of EGC when evaluated using subjective or objective criteria. [20][21][22][23][24] However, limited information is available concerning the efficacy of LCI for detecting EGC after eradication. Design of previous studies was unsatisfactory because only still images of EGC were evaluated.…”

Section: Introductionmentioning

confidence: 99%

Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white‐light imaging versus linked color imaging

Kitagawa

Suzuki

Nankinzan

et al. 2019

Digestive Endoscopy

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“…3.1 (0.9) 3.6 (0.6) 3.4 (0.7) 3.1 (0.8) 3.6 (0.6) 3.5 (0.6) 3.0 (0.9) 3.4 (0.7) 3. under LCI was unclear, but several reports have suggested that gastrointestinal neoplasia appears yellow or orange under LCI. 13,24 A high Da resulted in a significant difference in DE between LCI and WLI. Our results for the transparent condition were consistent with those of previous reports under air conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Our results for the transparent condition were consistent with those of previous reports under air conditions. 13,23,24 Under the cloudy condition, turbid and opaque fluid disrupted the view of the polyps. The transparent condition was maintained by irrigation using the water jet function; however, turbid fluid sometimes flowed from the proximal side of the polyps during underwater observation, and the entire view became reddish, and the lesional margin became unclear under BLI.…”

Section: Discussionmentioning

confidence: 99%

Blue laser imaging and linked color imaging improve the color difference value and visibility of colorectal polyps in underwater conditions

Yamasaki

Harada

Yamamoto

et al. 2020

Digestive Endoscopy

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Background and Aim Underwater endoscopic mucosal resection (UEMR) has become widespread for treating colorectal polyps. However, which observational mode is best suited for determining polyp margins underwater remains unclear. To determine the best mode, we analyzed three imaging modes: white light imaging (WLI), blue laser imaging (BLI) and linked color imaging (LCI). Methods Images of consecutive colorectal polyps previously examined by these three modes before UEMR were analyzed according to the degree of underwater turbidity (transparent or cloudy). Color differences between the polyps and their surroundings were calculated using the Commission Internationale d’Eclairage Lab color space in which 3‐D color parameters were expressed. Eight evaluators, who were blinded to the histology, scored the visibility from one (undetectable) to four (easily detectable) in both underwater conditions. The color differences and visibility scores were compared. Results Seventy‐three polyps were evaluated. Sixty‐one polyps (44 adenomatous, 17 serrated) were observed under transparent conditions, and 12 polyps (seven adenomatous, five serrated) were observed under cloudy conditions. Under transparent conditions, color differences for the BLI (8.5) and LCI (7.9) were significantly higher than that of WLI (5.7; P < 0.001). Visibility scores for BLI (3.6) and LCI (3.4) were also higher than that of WLI (3.1; P < 0.0001). Under cloudy conditions, visibility scores for LCI (2.9) and WLI (2.7) were significantly higher than that of BLI (2.2; P < 0.0001 and P = 0.04, respectively). Conclusions BLI and LCI were better observational modes in transparent water; however, BLI was unsuitable for cloudy conditions.

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“…Moreover, we will seek more accurate calculation methods. Regarding quantification of endoscopic findings related to EGC, other color component values (L * , a * , and b * ) [10] were used to confirm that LCI images have a higher color contrast between EGC and surrounding mucosa compared to WLI. In addition, the L * a * b * color space may even have an association with surface blood vessel density in EGC lesions [11].…”

Section: Discussionmentioning

confidence: 99%

RGB Pixel Brightness Characteristics of Linked Color Imaging in Early Gastric Cancer: A Pilot Study

Sun

Zhao

2020

Gastroenterology Research and Practice

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Background and Aims. Linked color imaging (LCI) helps screen and diagnose for early gastric cancer by color contrast in different mucosa. RGB (red, green, and blue) pixel brightness quantifies colors, which is relatively objective. Limited studies have combined LCI images with RGB to help screen for early gastric cancer (EGC). We aimed to evaluate the RGB pixel brightness characteristics of EGC and noncancer areas in LCI images. Methods. We retrospectively reviewed early gastric cancer (EGC) patients and LCI images. All pictures were evaluated by at least two endoscopic physicians. RGB pixel brightness analysis of LCI images was performed in MATLAB software to compare the cancer with noncancer areas. Receiver operating characteristic (ROC) curve was analyzed for sensitivity, specificity, cut-off, and area under the curve (AUC). Results. Overall, 38 early gastric cancer patients were enrolled with 38 LCI images. Pixel brightness of red, green, and blue in cancer was remarkably higher than those in noncancer areas (190.24±37.10 vs. 160.00±40.35, p<0.001; 117.96±33.91 vs. 105.33±30.01, p=0.039; 114.36±34.88 vs. 90.93±30.14, p<0.001, respectively). Helicobacter plyori (Hp) infection was not relevant to RGB distribution of EGC. Whether the score of Kyoto Classification of Gastritis (KCG) is ≥4 or <4, the pixel brightness of red, green, and blue was not disturbed in both cancer and noncancer (p>0.05). Receiver operating characteristic (ROC) curve for differentiating cancer from noncancer was calculated. The maximum area under the curve (AUC) was 0.767 in B/G, with a sensitivity of 0.605, a specificity of 0.921, and a cut-off of 0.97. Conclusions. RGB pixel brightness was useful and more objective in distinguishing early gastric cancer for LCI images.

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Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia

Cited by 64 publications

References 30 publications

Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white‐light imaging versus linked color imaging

Comparison of endoscopic visibility and miss rate for early gastric cancers after Helicobacter pylori eradication with white‐light imaging versus linked color imaging

Blue laser imaging and linked color imaging improve the color difference value and visibility of colorectal polyps in underwater conditions

RGB Pixel Brightness Characteristics of Linked Color Imaging in Early Gastric Cancer: A Pilot Study

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