Differences in color between early gastric cancer and cancer-suspected non-cancerous mucosa on linked color imaging

Abstract

Background and study aims Linked color imaging (LCI) can enhance the original color of each area and may useful to detect tumorous lesions during esophagogastroduodenoscopy. However, LCI may also enhance cancer-suspected non-cancerous regional color change. We conducted a retrospective image analysis to investigate the color characteristics of early gastric cancer (EGC) and cancer-suspected non-cancerous mucosa (CSM) in LCI.

Methods LCI images of both EGC and CSM were retrospectively collected from the database of the institution. Fifteen endoscopists individually judged each image as EGC or CSM. The color difference between the inside and outside of the lesions was measured by CIE-Lab analysis in both groups and compared.

Results A total of 245 LCI images of EGC (169) and CSM (76) were extracted and randomly lined for image collection. The test by the endoscopists showed accuracy, sensitivity, and specificity of 64.0 %, 63.7 %, and 64.0 %, respectively. Although the color difference between EGC and CSM was almost the same (12.5 vs. 12.9, not significant), each parameter of ΔL (bright: –0.3 vs. –2.7, P  < 0.001), Δa (Reddish: 7.2 vs. 9.6, P = 0.004), and Δb (Yellowish: 6.4 vs. 3.8, P  < 0.001) was significantly different in the groups. The color feature of both positive ΔL and Δb to EGC showed accuracy, sensitivity, and specificity of 54.7 %, 39.6 %, 88.2%, respectively.

Conclusions The total color difference was almost the same between EGC and CSM; however, their color tones were different on linked color imaging. Although the color characteristics of EGC had high specificity, they also had low sensitivity.

Publikationsverlauf

Eingereicht: 20. März 2022

Angenommen nach Revision: 13. Oktober 2022

Accepted Manuscript online:
29. November 2022

Artikel online veröffentlicht:
19. Januar 2023

• References

• 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
• 2 Ono H, Kondo H, Gotoda T. et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
• 3 Nakajima T, Oda I, Gotoda T. et al. Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?. Gastric Cancer 2006; 9: 93-98
• 4 Kato M, Nishida T, Yamamoto K. et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka university ESD Study Group. Gut 2013; 62: 1425-1432
• 5 Hamashima C. Systematic Review Group and Guideline Development Group for Gastric Cancer Screening Guidelines. Update version of the Japanese Guidelines for Gastric Cancer Screening. Jpn J Clin Oncol 2018; 48: 673-683
• 6 Pimenta-Melo AR, Monteiro-Soares M, Libânio D. et al. Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28: 1041-1049
• 7 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
• 8 Diao W, Huang X, Shen L. et al. Diagnostic ability of blue laser imaging combined with magnifying endoscopy for early esophageal cancer. Dig Liver Dis 2018; 50: 1035-1040
• 9 Ezoe Y, Muto M, Horimatsu T. et al. Magnifying narrow-band imaging versus magnifying white-light imaging for the differential diagnosis of gastric small depressed lesions: a prospective study. Gastrointest Endosc 2010; 71: 477-484
• 10 Ono S, Kawada K, Dohi O. et al. Linked color imaging focused on neoplasm detection in the upper gastrointestinal tract: a randomized trial. Ann Intern Med 2021; 174: 18-24
• 11 Kanzaki H, Takenaka R, Kawahara Y. et al. Linked color imaging (LCI), a novel image-enhanced endoscopy technology, emphasizes the color of early gastric cancer. Endosc Int Open 2017; 5: E1005-E1013
• 12 Fukuda H, Miura Y, Osawa H. et al. Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia. J Gastroenterol 2019; 54: 396-406
• 13 Ono S, Kato M, Tsuda M. et al. Lavender color in linked color imaging enables noninvasive detection of gastric intestinal metaplasia. Digestion 2018; 98: 222-230
• 14 Yao K, Uedo N, Kamada T. et al. Guidelines for endoscopic diagnosis of early gastric cancer. Dig Endosc 2020; 32: 663-698
• 15 Fujiwara T, Hirokado K, Yao T. et al. Observations on diagnostic problems in depressed type early gastric cancer. Stomach Intestine 1971; 6: 157-174
• 16 Honmyo U, Misumi A, Murakami A. et al. Mechanisms producing color change in flat early gastric cancers. Endoscopy 1997; 29: 366-371
• 17 Kuehni RG. Color-tolerance data and the tentative CIE 1976 lab formula. J Opt Soc Am 1976; 66: 497-500
• 18 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
• 19 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
• 20 Kanzaki H, Uedo N, Ishihara R. et al. Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic gastritis. Helicobacter 2012; 17: 224-231
• 21 Yamasaki Y, Uedo N, Kanzaki H. et al. Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis. Ann Gastroenterol 2017; 30: 302-308