The Efficacy of Linked Color Imaging in the Endoscopic Diagnosis of Barrett’s Esophagus and Esophageal Adenocarcinoma
Mamoru Tokunaga, Tomoaki Matsumura, Kentaro Ishikawa, Tatsuya Kaneko, Hirotaka Oura, Tsubasa Ishikawa, Ariki Nagashima, Wataru Shiratori, Kenichiro Okimoto, Naoki Akizue, Daisuke Maruoka, Yuki Ohta, Keiko Saito, Tomoo Nakagawa, Tetsuhiro Chiba, Makoto Arai, Jun Kato, Naoya Kato, Oronzo Brunetti
Abstract
Background. The present study aimed to evaluate the efficacy of linked color imaging (LCI) in diagnosing Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC). Methods. A total of 112 and 12 consecutive patients with BE and EAC were analyzed. The visibility scores of BE and EAC ranging from 4 (excellent visibility) to 0 (not detectable) were evaluated by three trainees and three experts using white light imaging (WLI), LCI mode, and blue laser imaging bright (BLI-b) mode. In addition, <inline-formula> <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>L</a:mtext> <a:mo>∗</a:mo> <a:mtext>a</a:mtext> <a:mo>∗</a:mo> <a:mtext>b</a:mtext> <a:mo>∗</a:mo> </a:math> </inline-formula> color values and color differences (<inline-formula> <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>Δ</c:mi> <c:mtext>E</c:mtext> <c:mo>∗</c:mo> </c:math> </inline-formula>) were evaluated using the CIELAB color space system. Results. The visibility score of the BE in LCI mode (<inline-formula> <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mn>2.94</e:mn> <e:mo>±</e:mo> <e:mn>1.32</e:mn> </e:math> </inline-formula>) was significantly higher than those in WLI (<inline-formula> <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mn>2.46</g:mn> <g:mo>±</g:mo> <g:mn>1.48</g:mn> </g:math> </inline-formula>) and BLI-b mode (<inline-formula> <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mn>2.35</i:mn> <i:mo>±</i:mo> <i:mn>1.46</i:mn> </i:math> </inline-formula>) (<inline-formula> <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo><</k:mo> <k:mn>0.01</k:mn> </k:math> </inline-formula>). The color difference (<inline-formula> <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>Δ</m:mi> <m:mtext>E</m:mtext> <m:mo>∗</m:mo> </m:math> </inline-formula>) from the adjacent gastric mucosa in LCI mode (<inline-formula> <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mn>17.11</o:mn> <o:mo>±</o:mo> <o:mn>8.53</o:mn> </o:math> </inline-formula>) was significantly higher than those in other modes (<inline-formula> <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mn>12.52</q:mn> <q:mo>±</q:mo> <q:mn>9.37</q:mn> </q:math> </inline-formula> in WLI and <inline-formula> <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mn>11.96</s:mn> <s:mo>±</s:mo> <s:mn>6.59</s:mn> </s:math> </inline-formula> in BLI-b mode, <inline-formula> <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>p</u:mi> <u:mo><</u:mo> <u:mn>0.01</u:mn> </u:math> </inline-formula>). The visibility scores of EAC in LCI mode (<inline-formula> <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mn>2.56</w:mn> <w:mo>±</w:mo> <w:mn>1.47</w:mn> </w:math> </inline-formula>) and BLI-b mode (<inline-formula> <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mn>2.51</y:mn> <y:mo>±</y:mo> <y:mn>1.28</y:mn> </y:math> </inline-formula>) were significantly higher than that in WLI (<inline-formula> <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mn>1.64</ab:mn> <ab:mo>±</ab:mo> <ab:mn>1.46</ab:mn> </ab:math> </inline-formula>) (<inline-formula> <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"> <cb:mi>p</cb:mi> <cb:mo><</cb:mo> <cb:mn>0.01</cb:mn> </cb:math> </inline-formula>). The color difference (<inline-formula> <eb:math xmlns:eb="http://www.w3.org/1998/Math/MathML" id="M16"> <eb:mi>Δ</eb:mi> <eb:mtext>E</eb:mtext> <eb:mo>∗</eb:mo> </eb:math> </inline-formula>) from the adjacent normal Barrett’s mucosa in LCI mode (<inline-formula> <gb:math xmlns:gb="http://www.w3.org/1998/Math/MathML" id="M17"> <gb:mn>19.96</gb:mn> <gb:mo>±</gb:mo> <gb:mn>7.97</gb:mn> </gb:math> </inline-formula>) was significantly higher than that in WLI (<inline-formula> <ib:math xmlns:ib="http://www.w3.org/1998/Math/MathML" id="M18"> <ib:mn>12.95</ib:mn> <ib:mo>±</ib:mo> <ib:mn>11.86</ib:mn> </ib:math> </inline-formula>) (<inline-formula> <kb:math xmlns:kb="http://www.w3.org/1998/Math/MathML" id="M19"> <kb:mi>p</kb:mi> <kb:mo>=</kb:mo> <kb:mn>0.03</kb:mn> </kb:math> </inline-formula>). Conclusion. The present findings suggest that LCI increases the visibility of BE and EAC and contributes to the improvement of the detection of these lesions.