Linked color imaging improves identification of early gastric cancer lesions by expert and non-expert endoscopists

Abstract

Background and aims Early gastric cancer (EGC) lesions are often subtle and endoscopically poorly visible. The aim of this study is to evaluate the additive effect of linked color imaging (LCI) next to white-light endoscopy (WLE) for identification of EGC, when assessed by expert and non-expert endoscopists. Methods Forty EGC cases were visualized in corresponding WLE and LCI images. Endoscopists evaluated the cases in 3 assessment phases: Phase 1: WLE images only; Phase 2: LCI images only; Phase 3: WLE and LCI images side-to-side. First, 3 expert endoscopists delineated all cases. A high level of agreement between the expert delineations corresponded with a high AND/OR ratio. Subsequently, 62 non-experts indicated their preferred biopsy location. Outcomes of the study are as follows: (1) difference in expert AND/OR ratio; (2) accuracy of biopsy placement by non-expert endoscopists; and (3) preference of imaging modality by non-expert endoscopists. Results Quantitative agreement between experts increased significantly when LCI was available (0.58 vs. 0.46, p = 0.007). This increase was more apparent for the more challenging cases (0.21 vs. 0.47, p < 0.001). Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, p < 0.001). Again this increase was more profound for the more challenging cases (70.4% vs. 83.4%, p < 0.001). Non-experts indicated to prefer LCI over WLE. Conclusion The addition of LCI next to WLE improves visualization of EGC. Experts reach higher consensus on discrimination between neoplasia and inflammation when using LCI. Non-experts improve their targeted biopsy placement with the use of LCI. LCI therefore appears to be a useful tool for identification of EGC. Graphical abstract

Current status and future perspective of linked color imaging for gastric cancer screening: a literature review

“…The proportion of overlooked neoplasms was lower in the LCI group (0.67%) than in the WLI group (3.5%); risk ratio, 0.19 [CI 0.07–0.50] Hiraoka et al [ 65 ] 2021 Retrospective/SC 40 Images of EGCs and surrounding mucosa The mean visibility scores for LCI with C2 enhancement were significantly higher than those with C1 enhancement. LCI with C2 enhancement tended to produce a color difference between the malignant lesions and the surrounding mucosa Fockens et al [ 66 ] 2022 Retrospective/MC 40 EGC lesions Images of EGCs Experts reached higher consensus on discrimination between neoplasia and inflammation when using LCI. Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, P < 0.001).…”

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

“…Recently, Fockens et al . reported that LCI enabled recognition of lesions to be biopsied more accurately than did WLI for nonexperts, but there was no comparison with experts 22 . Yoshifuku et al .…”

“…Recently, Fockens et al reported that LCI enabled recognition of lesions to be biopsied more accurately than did WLI for nonexperts, but there was no comparison with experts. 22 Yoshifuku et al also reported that LCI significantly improved the visibility of gastric cancer compared with blue laser imaging regardless of the doctor's experience. 23 Our data showed that LCI was advantageous for nonexperts, especially novices, in detecting epithelial lesions.…”

Towards a robust and compact deep learning system for primary detection of early Barrett’s neoplasia: Initial image‐based results of training on a multi‐center retrospectively collected data set

“…The first test set was benchmarked by 52 general endoscopists originating from 3 countries to provide a reference for CADe performance. A previously designed web‐based module (Meducati AB, Göteborg, Sweden) was used and adjusted for this specific study 15,16 . For each endoscopic image, the endoscopists indicated if they detected neoplasia and, where applicable, placed a biopsy mark on the most abnormal part of the lesion.…”

“…A previously designed web‐based module (Meducati AB, Göteborg, Sweden) was used and adjusted for this specific study. 15 , 16 For each endoscopic image, the endoscopists indicated if they detected neoplasia and, where applicable, placed a biopsy mark on the most abnormal part of the lesion. This mark represents the location where they would have taken a targeted biopsy during real‐time endoscopic examination.…”