Linked color imaging (LCI), a novel image-enhanced endoscopy technology, emphasizes the color of early gastric cancer

Abstract

Background and study aims Linked color imaging (LCI) and blue laser imaging (BLI) are novel image-enhanced endoscopy technologies with strong, unique color enhancement. We investigated the efficacy of LCI and BLI-bright compared to conventional white light imaging (WLI) by measuring the color difference between early gastric cancer lesions and the surrounding mucosa.

Patients and methods Images of early gastric cancer scheduled for endoscopic submucosal dissection were captured by LCI, BLI-bright, and WLI under the same conditions. Color values of the lesion and surrounding mucosa were defined as the average of the color value in each region of interest. Color differences between the lesion and surrounding mucosa (ΔE) were examined in each mode. The color value was assessed using the CIE L*a*b* color space (CIE: Commission Internationale d’Eclairage).

Results We collected images of 43 lesions from 42 patients. Average ΔE values with LCI, BLI-bright, and WLI were 11.02, 5.04, and 5.99, respectively. The ΔE was significantly higher with LCI than with WLI (P < 0.001). Limited to cases of small ΔE with WLI, the ΔE was approximately 3 times higher with LCI than with WLI (7.18 vs. 2.25). The ΔE with LCI was larger when the surrounding mucosa had severe intestinal metaplasia (P = 0.04). The average color value of a lesion and the surrounding mucosa differed. This value did not have a sufficient cut-off point between the lesion and surrounding mucosa to distinguish them, even with LCI.

Conclusion LCI had a larger ΔE than WLI. It may allow easy recognition and early detection of gastric cancer, even for inexperienced endoscopists.

• References

• 1 Stewart BW, Wild CP. World cancer report 2014. Lyon: World Health Organization; 2014
• 2 Nieminen A, Kokkola A, Yla-Liedenpohja J. et al. Early gastric cancer: clinical characteristics and results of surgery. Dig Surg 2009; 26: 378-383
• 3 Oh HJ, Kim JS. Clinical practice guidelines for endoscope reprocessing. Clin Endosc 2015; 48: 364-368
• 4 Jang JY. The past, present, and future of image-enhanced endoscopy. Clin Endosc 2015; 48: 466-475
• 5 Nam SY, Choi IJ, Park KW. et al. Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastroenterol Hepatol 2009; 21: 855-860
• 6 Lee HL, Eun CS, Lee OY. et al. When do we miss synchronous gastric neoplasms with endoscopy?. Gastrointest Endosc 2010; 71: 1159-1165
• 7 Raftopoulos SC, Segarajasingam DS, Burke V. et al. A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol 2010; 105: 1292-1297
• 8 Muto M, Minashi K, Yano T. et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2010; 28: 1566-1572
• 9 Takenaka R, Kawahara Y, Okada H. et al. Narrow-band imaging provides reliable screening for esophageal malignancy in patients with head and neck cancers. Am J Gastroenterol 2009; 104: 2942-2948
• 10 Ishihara R, Inoue T, Hanaoka N. et al. Autofluorescence imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia: a phase II study. J Gastroenterol Hepatol 2012; 27: 86-90
• 11 Dohi O, Yagi N, Majima A. et al. Diagnostic ability of magnifying endoscopy with blue laser imaging for early gastric cancer: a prospective study. Gastric Cancer 2017; 20: 297-303
• 12 Nakayoshi T, Tajiri H, Matsuda K. et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 2004; 36: 1080-1084
• 13 Ezoe Y, Muto M, Horimatsu T. et al. Magnifying narrow-band imaging versus magnifying white-light imaging for the differential diagnosis of gastric small depressive lesions: a prospective study. Gastrointest Endosc 2010; 71: 477-484
• 14 Ezoe Y, Muto M, Uedo N. et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 2011; 141: 2017-2025
• 15 Tada K, Oda I, Yokoi C. et al. Pilot study on clinical effectiveness of autofluorescence imaging for early gastric cancer diagnosis by less experienced endoscopists. Diagn Ther Endosc 2011; DOI: 10.1155/ 2011/ 419136.
• 16 Xirouchakis E, Laoudi F, Tsartsali L. et al. Screening for gastric premalignant lesions with narrow band imaging, white light and updated Sydney protocol or both?. Dig Dis Sci 2013; 58: 1084-90
• 17 Dohi O, Yagi N, Onozawa Y. et al. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open 2016; 4: E800-E805
• 18 Sun X, Dong T, Bi Y. et al. Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study. Sci Rep 2016; 6: 33473
• 19 Ono S, Abiko S, Kato M. Linked color imaging enhances gastric cancer in gastric intestinal metaplasia. Dig Endosc 2017; 29: 230-231
• 20 Fukuda H, Miura Y, Hayashi Y. et al. Linked color imaging technology facilitates early detection of flat gastric cancers. Clin J Gastroenterol 2015; 8: 385-389
• 21 Suzuki T, Hara T, Kitagawa Y. et al. Magnified endoscopic observation of early colorectal cancer by linked color imaging with crystal violet staining (with video). Gastrointest Endosc 2016; 84: 726-729
• 22 Kaneko K, Oono Y, Yano T. et al. Effect of novel bright image enhanced endoscopy using blue laser imaging (BLI). Endosc Int Open 2014; 2: E212-E219
• 23 Kuehni RG. Color-tolerance data and the tentative CIE 1976 Lab formula. J Opt Soc Am 1976; 66: 497-500
• 24 Sato Y, Sagawa T, Hirakawa M. et al. Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions. Endosc Int Open 2014; 2: E80-E87
• 25 Waldemarin RF, Terra PC, Pinto LR. et al. Color change in acrylic resin processed in three ways after immersion in water, cola, coffee, mate and wine. Acta Odontol Latinoam 2013; 26: 138-143
• 26 Central Bureau of CIE [International Commission on Illumination]. Colorimetry – Technical Report. CIE Pub. No. 15. 3rd ed. Vienna: International Commission on Illumination; 2004 Available: http://www.cdvplus.cz/file/3-publikace-cie15-2004/ (Accessed 2017 Feb 19)
• 27 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 3: 87-97
• 28 Nagata K, Shimizu M. Pathological evaluation of gastrointestinal endoscopic submucosal dissection materials based on Japanese guidelines. World J Gastrointest Endosc 2012; 4: 489-499
• 29 Dixon MF, Genta RM, Yardley JH. et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
• 30 Correa P. Helicobacter pylori and gastric carcinogenesis. Am J Surg Pathol 1995; 19: S37-S42
• 31 Kato M, Terao S, Adachi K. et al. Changes in endoscopic findings of gastritis after cure of H. pylori infection: multicenter prospective trial. Dig Endosc 2013; 25: 264-273
• 32 Suzuki T, Hara T, Kitagawa Y. et al. Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions. Gastrointestinal Endosc 2017; DOI: 10.1016/ j.gie.2017.01.044.