Utility of linked color imaging for endoscopic diagnosis of early gastric cancer
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摘要
BACKGROUND Linked color imaging(LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal color.AIM To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological findings.METHODS Endoscopic images were obtained for 39 patients(43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging(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.RESULTS LCI was superior for lesion recognition(P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI(29.4 vs 18.6, P <0.0001). Blood vessel density was significantly higher in cancer lesions(5.96% vs4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%.CONCLUSION LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.
BACKGROUND Linked color imaging(LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal color.AIM To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological findings.METHODS Endoscopic images were obtained for 39 patients(43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging(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.RESULTS LCI was superior for lesion recognition(P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI(29.4 vs 18.6, P <0.0001). Blood vessel density was significantly higher in cancer lesions(5.96% vs4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%.CONCLUSION LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.
BACKGROUND Linked color imaging(LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal color.AIM To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological findings.METHODS Endoscopic images were obtained for 39 patients(43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging(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.RESULTS LCI was superior for lesion recognition(P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI(29.4 vs 18.6, P <0.0001). Blood vessel density was significantly higher in cancer lesions(5.96% vs4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%.CONCLUSION LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.
引文
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2 Hori M,Matsuda T,Shibata A,Katanoda K,Sobue T,Nishimoto H;Japan Cancer Surveillance Research Group.Cancer incidence and incidence rates in Japan in 2009:a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan(MCIJ)project.Jpn J Clin Oncol 2015;45:884-891[PMID:26142437 DOI:10.1093/jjco/hyv088]
3 Yao K,Yao T,Iwashita A.Determining the horizontal extent of early gastric carcinoma:two modern techniques based of differences in the mucosal microvascular architecture and density between carcinomatous and non-carcinomatous mucosa.Dig Endosc 2002;14:83-87[DOI:10.1046/j.1443-1661.14.s1.16.x]
4 Yao K,Oishi T,Matsui T,Yao T,Iwashita A.Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer.Gastrointest Endosc 2002;56:279-284[PMID:12145613]
5 Gono K,Obi T,Yamaguchi M,Ohyama N,Machida H,Sano Y,Yoshida S,Hamamoto Y,Endo T.Appearance of enhanced tissue features in narrow-band endoscopic imaging.J Biomed Opt 2004;9:568-577[PMID:15189095 DOI:10.1117/1.1695563]
6 Yao K,Anagnostopoulos GK,Ragunath K.Magnifying endoscopy for diagnosing and delineating early gastric cancer.Endoscopy 2009;41:462-467[PMID:19418401 DOI:10.1055/s-0029-1214594]
7 Nagahama T,Yao K,Maki S,Yasaka M,Takaki Y,Matsui T,Tanabe H,Iwashita A,Ota A.Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy(with video).Gastrointest Endosc 2011;74:1259-1267[PMID:22136775 DOI:10.1016/j.gie.2011.09.005]
8 Yao K,Nagahama T,Hirai F,Sou S,Matsui T,Tanabe H,Iwashita A,Ragunath K.Clinical application of magnification endoscopy with NBI in the stomach and the duodenum.Cohen J,editor.Comprehensive atlas of high-resolution endoscopy.Oxford:Blackwell Publishing 2007;83-103[DOI:10.1002/9781118705940]
9 Muto M,Nakane M,Katada C,Sano Y,Ohtsu A,Esumi H,Ebihara S,Yoshida S.Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites.Cancer 2004;101:1375-1381[PMID:15368325 DOI:10.1002/cncr.20482]
10 Muto M,Minashi K,Yano T,Saito Y,Oda I,Nonaka S,Omori T,Sugiura H,Goda K,Kaise M,Inoue H,Ishikawa H,Ochiai A,Shimoda T,Watanabe H,Tajiri H,Saito D.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[PMID:20177025 DOI:10.1200/JCO.2009.25.4680]
11 Goda K,Tajiri H,Ikegami M,Urashima M,Nakayoshi T,Kaise M.Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma.Gastrointest Endosc 2007;65:36-46[PMID:17185078 DOI:10.1016/j.gie.2006.03.938]
12 Osawa H,Yamamoto H.Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology.Dig Endosc 2014;26 Suppl 1:105-115[PMID:24373002 DOI:10.1111/den.12205]
13 Yoshida N,Hisabe T,Inada Y,Kugai M,Yagi N,Hirai F,Yao K,Matsui T,Iwashita A,Kato M,Yanagisawa A,Naito Y.The ability of a novel blue laser imaging system for the diagnosis of invasion depth of colorectal neoplasms.J Gastroenterol 2014;49:73-80[PMID:23494646 DOI:10.1007/s00535-013-0772-7]
14 Dohi O,Yagi N,Onozawa Y,Kimura-Tsuchiya R,Majima A,Kitaichi T,Horii Y,Suzuki K,Tomie A,Okayama T,Yoshida N,Kamada K,Katada K,Uchiyama K,Ishikawa T,Takagi T,Handa O,Konishi H,Naito Y,Itoh Y.Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection.Endosc Int Open 2016;4:E800-E805[PMID:27556101 DOI:10.1055/s-0042-109049]
15 Commission Internationale de l’Eclairage.Colorimetry,3rd Edition Publication CIE 15:2004.Available from:http://www.cie.co.at/publications/colorimetry-3rd-edition
16 Yoshifuku Y,Sanomura Y,Oka S,Kurihara M,Mizumoto T,Miwata T,Urabe Y,Hiyama T,Tanaka S,Chayama K.Evaluation of the visibility of early gastric cancer using linked color imaging and blue laser imaging.BMC Gastroenterol 2017;17:150[PMID:29216843 DOI:10.1186/s12876-017-0707-5]
17 Kanesaka T,Uedo N,Yao K,Ezoe Y,Doyama H,Oda I,Kaneko K,Kawahara Y,Yokoi C,Sugiura Y,Ishikawa H,Kato M,Takeuchi Y,Muto M,Saito Y.A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer.Endosc Int Open 2015;3:E590-E596[PMID:26716118 DOI:10.1055/s-0034-1392608]
18 Ohashi A,Niwa Y,Ohmiya N,Miyahara R,Itoh A,Hirooka Y,Goto H.Quantitative analysis of the microvascular architecture observed on magnification endoscopy in cancerous and benign gastric lesions.Endoscopy 2005;37:1215-1219[PMID:16329020 DOI:10.1055/s-2005-870339]
19 Kaise M,Kato M,Urashima M,Arai Y,Kaneyama H,Kanzazawa Y,Yonezawa J,Yoshida Y,Yoshimura N,Yamasaki T,Goda K,Imazu H,Arakawa H,Mochizuki K,Tajiri H.Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions.Endoscopy2009;41:310-315[PMID:19340733 DOI:10.1055/s-0028-1119639]
20 Araki Y,Sasaki Y,Hanabata N,Yoshimura T,Sawaya M,Hada R,Fukuda S.Morphometry for microvessels in early gastric cancer by narrow band imaging-equipped magnifying endoscopy.Dig Endosc2011;23:233-239[PMID:21699567 DOI:10.1111/j.1443-1661.2010.01093.x]
21 Adachi Y,Mori M,Enjoji M,Sugimachi K.Microvascular architecture of early gastric carcinoma.Microvascular-histopathologic correlates.Cancer 1993;72:32-36[PMID:8508426]
22 Takemura S,Iwashita A,Yao K,Yao T.The correlation between the quantified microvascular density and the endoscopic color in elevated type of gastric neoplastic lesions.Gastroenterol Endosc 2002;44:745-754[DOI:10.11280/gee1973b.44.745]
23 Honmyo U,Misumi A,Murakami A,Mizumoto S,Yoshinaka I,Maeda M,Yamamoto S,Shimada S.Mechanisms producing color change in flat early gastric cancers.Endoscopy 1997;29:366-371[PMID:9270917 DOI:10.1055/s-2007-1004217]
24 Furukawa K,Yao K,Iwashita A,Matsui T,Yao T.Microvascular architecture of depressed type early gastric cancer-quantified vascular density using computer analysis with special reference to the color of endoscopic findings.Gastroenterol Endosc 1997;39:1358-1369[DOI:10.11280/gee1973b.39.1358]
25 Yamaguchi H,Saito T,Shiraishi Y,Arai F,Morimoto Y,Yuasa A.Quantitative study on appearance of microvessels in spectral endoscopic imaging.J Biomed Opt 2015;20:036005[PMID:25751029 DOI:10.1117/1.JBO.20.3.036005]
2 Hori M,Matsuda T,Shibata A,Katanoda K,Sobue T,Nishimoto H;Japan Cancer Surveillance Research Group.Cancer incidence and incidence rates in Japan in 2009:a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan(MCIJ)project.Jpn J Clin Oncol 2015;45:884-891[PMID:26142437 DOI:10.1093/jjco/hyv088]
3 Yao K,Yao T,Iwashita A.Determining the horizontal extent of early gastric carcinoma:two modern techniques based of differences in the mucosal microvascular architecture and density between carcinomatous and non-carcinomatous mucosa.Dig Endosc 2002;14:83-87[DOI:10.1046/j.1443-1661.14.s1.16.x]
4 Yao K,Oishi T,Matsui T,Yao T,Iwashita A.Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer.Gastrointest Endosc 2002;56:279-284[PMID:12145613]
5 Gono K,Obi T,Yamaguchi M,Ohyama N,Machida H,Sano Y,Yoshida S,Hamamoto Y,Endo T.Appearance of enhanced tissue features in narrow-band endoscopic imaging.J Biomed Opt 2004;9:568-577[PMID:15189095 DOI:10.1117/1.1695563]
6 Yao K,Anagnostopoulos GK,Ragunath K.Magnifying endoscopy for diagnosing and delineating early gastric cancer.Endoscopy 2009;41:462-467[PMID:19418401 DOI:10.1055/s-0029-1214594]
7 Nagahama T,Yao K,Maki S,Yasaka M,Takaki Y,Matsui T,Tanabe H,Iwashita A,Ota A.Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy(with video).Gastrointest Endosc 2011;74:1259-1267[PMID:22136775 DOI:10.1016/j.gie.2011.09.005]
8 Yao K,Nagahama T,Hirai F,Sou S,Matsui T,Tanabe H,Iwashita A,Ragunath K.Clinical application of magnification endoscopy with NBI in the stomach and the duodenum.Cohen J,editor.Comprehensive atlas of high-resolution endoscopy.Oxford:Blackwell Publishing 2007;83-103[DOI:10.1002/9781118705940]
9 Muto M,Nakane M,Katada C,Sano Y,Ohtsu A,Esumi H,Ebihara S,Yoshida S.Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites.Cancer 2004;101:1375-1381[PMID:15368325 DOI:10.1002/cncr.20482]
10 Muto M,Minashi K,Yano T,Saito Y,Oda I,Nonaka S,Omori T,Sugiura H,Goda K,Kaise M,Inoue H,Ishikawa H,Ochiai A,Shimoda T,Watanabe H,Tajiri H,Saito D.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[PMID:20177025 DOI:10.1200/JCO.2009.25.4680]
11 Goda K,Tajiri H,Ikegami M,Urashima M,Nakayoshi T,Kaise M.Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma.Gastrointest Endosc 2007;65:36-46[PMID:17185078 DOI:10.1016/j.gie.2006.03.938]
12 Osawa H,Yamamoto H.Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology.Dig Endosc 2014;26 Suppl 1:105-115[PMID:24373002 DOI:10.1111/den.12205]
13 Yoshida N,Hisabe T,Inada Y,Kugai M,Yagi N,Hirai F,Yao K,Matsui T,Iwashita A,Kato M,Yanagisawa A,Naito Y.The ability of a novel blue laser imaging system for the diagnosis of invasion depth of colorectal neoplasms.J Gastroenterol 2014;49:73-80[PMID:23494646 DOI:10.1007/s00535-013-0772-7]
14 Dohi O,Yagi N,Onozawa Y,Kimura-Tsuchiya R,Majima A,Kitaichi T,Horii Y,Suzuki K,Tomie A,Okayama T,Yoshida N,Kamada K,Katada K,Uchiyama K,Ishikawa T,Takagi T,Handa O,Konishi H,Naito Y,Itoh Y.Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection.Endosc Int Open 2016;4:E800-E805[PMID:27556101 DOI:10.1055/s-0042-109049]
15 Commission Internationale de l’Eclairage.Colorimetry,3rd Edition Publication CIE 15:2004.Available from:http://www.cie.co.at/publications/colorimetry-3rd-edition
16 Yoshifuku Y,Sanomura Y,Oka S,Kurihara M,Mizumoto T,Miwata T,Urabe Y,Hiyama T,Tanaka S,Chayama K.Evaluation of the visibility of early gastric cancer using linked color imaging and blue laser imaging.BMC Gastroenterol 2017;17:150[PMID:29216843 DOI:10.1186/s12876-017-0707-5]
17 Kanesaka T,Uedo N,Yao K,Ezoe Y,Doyama H,Oda I,Kaneko K,Kawahara Y,Yokoi C,Sugiura Y,Ishikawa H,Kato M,Takeuchi Y,Muto M,Saito Y.A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer.Endosc Int Open 2015;3:E590-E596[PMID:26716118 DOI:10.1055/s-0034-1392608]
18 Ohashi A,Niwa Y,Ohmiya N,Miyahara R,Itoh A,Hirooka Y,Goto H.Quantitative analysis of the microvascular architecture observed on magnification endoscopy in cancerous and benign gastric lesions.Endoscopy 2005;37:1215-1219[PMID:16329020 DOI:10.1055/s-2005-870339]
19 Kaise M,Kato M,Urashima M,Arai Y,Kaneyama H,Kanzazawa Y,Yonezawa J,Yoshida Y,Yoshimura N,Yamasaki T,Goda K,Imazu H,Arakawa H,Mochizuki K,Tajiri H.Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions.Endoscopy2009;41:310-315[PMID:19340733 DOI:10.1055/s-0028-1119639]
20 Araki Y,Sasaki Y,Hanabata N,Yoshimura T,Sawaya M,Hada R,Fukuda S.Morphometry for microvessels in early gastric cancer by narrow band imaging-equipped magnifying endoscopy.Dig Endosc2011;23:233-239[PMID:21699567 DOI:10.1111/j.1443-1661.2010.01093.x]
21 Adachi Y,Mori M,Enjoji M,Sugimachi K.Microvascular architecture of early gastric carcinoma.Microvascular-histopathologic correlates.Cancer 1993;72:32-36[PMID:8508426]
22 Takemura S,Iwashita A,Yao K,Yao T.The correlation between the quantified microvascular density and the endoscopic color in elevated type of gastric neoplastic lesions.Gastroenterol Endosc 2002;44:745-754[DOI:10.11280/gee1973b.44.745]
23 Honmyo U,Misumi A,Murakami A,Mizumoto S,Yoshinaka I,Maeda M,Yamamoto S,Shimada S.Mechanisms producing color change in flat early gastric cancers.Endoscopy 1997;29:366-371[PMID:9270917 DOI:10.1055/s-2007-1004217]
24 Furukawa K,Yao K,Iwashita A,Matsui T,Yao T.Microvascular architecture of depressed type early gastric cancer-quantified vascular density using computer analysis with special reference to the color of endoscopic findings.Gastroenterol Endosc 1997;39:1358-1369[DOI:10.11280/gee1973b.39.1358]
25 Yamaguchi H,Saito T,Shiraishi Y,Arai F,Morimoto Y,Yuasa A.Quantitative study on appearance of microvessels in spectral endoscopic imaging.J Biomed Opt 2015;20:036005[PMID:25751029 DOI:10.1117/1.JBO.20.3.036005]