TY - JOUR
T1 - Linked color imaging improves identification of early gastric cancer lesions by expert and non-expert endoscopists
AU - Fockens, Kiki
AU - de Groof, Jeroen
AU - van der Putten, Joost
AU - Khurelbaatar, Tsevelnorov
AU - Fukuda, Hisashi
AU - Takezawa, Takahito
AU - Miura, Yoshimasa
AU - Osawa, Hiroyuki
AU - Yamamoto, Hironori
AU - Bergman, Jacques
N1 - Funding Information: Dr. Jacques Bergman has received research grants from Fujifilm, Olympus, and Pentax and has received honoraria from Fujifilm and Olympus. Dr. Jeroen de Groof has received printing costs for his thesis. Dr. Yoshimasa Miura has received honoraria from Fujifilm. Dr. Hiroyuki Osawa has received honoraria from Fujifilm. Dr. Hironori Yamamoto has received honoraria and research grants from Fujifilm and is a consultant of Fujifilm. Drs. Kiki Fockens, Joost van der Putten, Tsevelnorov Khurelbaatar, Hisashi Fukuda, and Takahito Takezawa have no conflicts of interest or financial ties to disclose. Publisher Copyright: © 2022, The Author(s).
PY - 2022/11
Y1 - 2022/11
N2 - 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: [Figure not available: see fulltext.]
AB - 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: [Figure not available: see fulltext.]
KW - Early gastric cancer
KW - Linked color imaging
KW - Optical enhancement
UR - http://www.scopus.com/inward/record.url?scp=85129532022&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-022-09280-0
DO - https://doi.org/10.1007/s00464-022-09280-0
M3 - Article
C2 - 35508665
SN - 0930-2794
VL - 36
SP - 8316
EP - 8325
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 11
ER -