Linked color imaging provides enhanced visibility with a high color difference in upper gastrointestinal neoplasms

Abstract

Background and Aim The aim of this post‐hoc analysis in a randomized, controlled, multicenter trial was to evaluate the visibility of upper gastrointestinal (UGI) neoplasms detected using linked color imaging (LCI) compared with those detected using white light imaging (WLI). Methods The visibility of the detected UGI neoplasm images obtained using both WLI and LCI was subjectively reviewed, and the median color difference (ΔE) between each lesion and the surrounding mucosa according to the CIE L*a*b* color space was evaluated objectively. Multivariate logistic regression analysis was performed to identify factors associated with neoplasms that were missed under WLI and detected under LCI. Results A total of 120 neoplasms, including 10, 32, and 78 neoplasms in the pharynx, esophagus, and stomach, respectively, were analyzed in this study. LCI enhanced the visibility 80.9% and 93.6% of neoplasms in pharynx/esophagus and stomach compared with WLI, respectively. LCI also achieved a higher ΔE of enhanced neoplasms compared with WLI in the pharynx/esophagus and stomach. The median WLI ΔE values for gastric neoplasms missed under WLI and later detected under LCI were significantly lower than those for gastric neoplasms detected under WLI (8.2 vs 9.6, respectively). Furthermore, low levels of WLI ΔE (odds ratio [OR], 7.215) and high levels of LCI ΔE (OR, 22.202) were significantly associated with gastric neoplasms missed under WLI and later detected under LCI. Conclusion Color differences were independently associated with missing gastric neoplasms under WLI, suggesting that LCI has an obvious advantage over WLI in enhancing neoplastic visibility.

Diagnostic performance of linked color imaging for gastric cancer by Helicobacter pylori infection status: A subanalysis of the large‐scale, multicenter randomized controlled trial LCI‐FIND

“…Subsequent studies comparing LCI and WLI for the detection of neoplastic lesions also showed the superiority of LCI 7,8 . Subanalysis proved that LCI enhanced neoplastic visibility with high frequency and showed a significant color difference between neoplasms and the surrounding non‐neoplastic mucosae compared with WLI in stomach 9 . In the present study, we used data from the LCI‐FIND trial to evaluate the diagnostic performances of WLI and LCI for gastric cancer according to H. pylori infection status.…”

Variation in the rate of detection of minute and small early gastric cancers at diagnostic endoscopy may reflect the performance of individual endoscopists

“…To our knowledge, only a few publications describe the parameters influencing gastric neoplasm detection (eg, rate of detection of gastric subepithelial lesions and diverticula,30 photodocumentation of the ampulla,31 endoscopist BR,32 average examination time10 33 and use of IEE34 35); however, unlike the ADR in colonoscopy, these parameters are not feasible candidates of easy-to-understand performance indicator for EGD because gastric neoplasm detection has not been an identified performance measure of EGD. The minimum requirements for maintaining endoscopy quality might be defined by photodocumentation of endoscopic images, the endoscopist BR or examination time.…”

Surveillance esophagogastroduodenoscopy using linked color imaging and narrow‐band imaging: A multicenter randomized controlled trial

“…11,12 Recently, a multicenter, randomized controlled trial and sub-analysis studies have shown that the ability of LCI to detect neoplastic lesions in the UGI tract is superior to that of WLI. [13][14][15] There has been no direct comparison between NBI and LCI for the detection of UGI neoplasms. As NBI and LCI are used in different endoscopy systems, endoscopists can only use either of the IEE systems on one patient, regardless of whether they are able to choose an endoscopy system or not.…”

“…White light and short‐wavelength light, including 410‐nm (blue violet) light and 450‐nm (blue) light at an appropriate ratio, are simultaneously irradiated, and LCI images are captured by computerized image processing 11,12 . Recently, a multicenter, randomized controlled trial and sub‐analysis studies have shown that the ability of LCI to detect neoplastic lesions in the UGI tract is superior to that of WLI 13–15 …”