Utility of linked color imaging for endoscopic diagnosis of early gastric cancer

doi:10.3748/wjg.v25.i10.1248

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Mar 14, 2019; 25(10): 1248-1258
Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1248

Utility of linked color imaging for endoscopic diagnosis of early gastric cancer

Toshihisa Fujiyoshi, Ryoji Miyahara, Kohei Funasaka, Kazuhiro Furukawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Masato Nakaguro, Masahiro Nakatochi, Yoshiki Hirooka

Toshihisa Fujiyoshi, Ryoji Miyahara, Kohei Funasaka, Kazuhiro Furukawa, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan

Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Yoshiki Hirooka, Department of Endoscopy, Nagoya University Hospital, Nagoya 4668560, Japan

Masato Nakaguro, Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 4668560, Japan

Masahiro Nakatochi, Division of Data Science, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya 4668560, Japan

Author contributions: Fujiyoshi T and Miyahara R designed and performed the research; Fujiyoshi T, Nakaguro M and Nakatochi M analyzed the data. Fujiyoshi T and Miyahara R wrote the paper. Miyahara R, Funasaka K, Furukawa K, Sawada T, Maeda K, Yamamura T, Ishikawa T, Ohno E, Nakamura M and Kawashima H provided the critical review of the manuscript. Hirooka Y provided administrative support and supervised the study.

Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Nagoya University Hospital.

Informed consent statement: All study participants provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.

Data sharing statement: No additional data are available.

Corresponding author: Ryoji Miyahara, MD, PhD, Associate Professor, Chief Doctor, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan. myhr@med.nagoya-u.ac.jp

Telephone: +81-52-7442172 Fax: +81-52-7442180

Received: December 31, 2018
Peer-review started: January 2, 2019
First decision: January 18, 2019
Revised: February 14, 2019
Accepted: February 15, 2019
Article in press: February 16, 2019
Published online: March 14, 2019
Processing time: 74 Days and 12.2 Hours

ARTICLE HIGHLIGHTS

Research background

Linked color imaging (LCI) emphasizes slight differences in the “red” color of the mucosa by image processing, including enhancement of differences in chroma and hue of the red mucosal color.

Research motivation

The utility of LCI for diagnosis of Helicobacter pylori gastritis has been well described, but there are few studies of LCI for diagnosis of gastrointestinal cancer and, to our knowledge, parallel analyses of LCI, white light imaging (WLI), and pathology samples have not been reported.

Research objectives

The objectives of this study are to evaluate the utility of LCI for endoscopic diagnosis of early gastric cancer and to examine if pathological findings can explain the changes in red shade in LCI.

Research methods

Three endoscopists evaluated lesion recognition with WLI and LCI. Color values in Commission Internationale de l'Eclairage (CIE) 1976 L*a*b* color space were used to calculate the color difference (ΔE) between cancer lesions and non-cancer areas. After endoscopic submucosal dissection, blood vessel density in the surface layer of the gastric epithelium was evaluated pathologically. The identical region of interest was selected for analyses of endoscopic images (WLI and LCI) and pathological analyses.

Research results

LCI gave better contrast than WLI for the color difference between cancer lesions and surrounding non-cancer tissue; an a* cutoff ≥ 24 for the value in CIE 1976 L*a*b* color space had good sensitivity and specificity for diagnosis of early gastric cancer; and surface blood vessel density in cancer lesions was significantly higher than that in non-cancer areas.

Research conclusions

LCI was useful for recognition of early gastric cancer lesions because this method provides good contrast in color differences between lesions and surrounding tissue. Blood vessel density from the surface to a depth of 350 μm was higher in cancer lesions than in non-cancer areas, and LCI clearly shows this feature as a change in redness.

Research perspectives

If these color values are evaluable in real time, artificial intelligence may permit automatic recognition and diagnosis of lesions.