Top

Published in:

01-05-2019 | Original Article—Alimentary Tract

Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia

Authors: Hisashi Fukuda, Yoshimasa Miura, Hiroyuki Osawa, Takahito Takezawa, Yuji Ino, Masahiro Okada, Tsevelnorov Khurelbaatar, Alan Kawarai Lefor, Hironori Yamamoto

Published in: Journal of Gastroenterology | Issue 5/2019

Abstract

Background

Linked color imaging (LCI) increases the visibility of early gastric cancers, which may be associated with characteristic findings including background purple mucosae. These lesions are found in areas of chronic gastritis and surrounding mucosa. The aim of this study is to objectively characterize these lesions by color differences and color component values using LCI.

Methods

Fifty-two patients with early gastric cancer were enrolled. Color differences were calculated prospectively in malignant lesions and adjacent mucosa and compared with histological findings in resected specimens. Color component values of L*, a*, and b* were compared between purple and non-purple mucosae in areas of chronic gastritis. Based on histological findings, the accuracy of identifying gastric intestinal metaplasia was calculated.

Results

Cancers and surrounding mucosa in 74% of lesions had similar colors using white light imaging (WLI), whereas purple mucosa surrounded part or all of cancers appearing orange–red, orange or orange–white using LCI. Greater color differences were seen using LCI compared to WLI, including flat-type cancers, leading to higher contrast. The surrounding purple mucosa corresponded histologically to intestinal metaplasia, facilitating the identification of malignant lesions. Forty lesions (83%) with purple mucosa and eight lesions (17%) with non-purple mucosa in areas of chronic gastritis were diagnosed as intestinal metaplasia by biopsy (83% accuracy). Color component values of purple mucosa differ significantly from those of non-purple mucosae.

Conclusions

LCI images have higher color contrast between early gastric cancers and surrounding mucosa compared to WLI. A characteristic purple color around gastric cancers using LCI represents intestinal metaplasia.

Honmyo U, Misumi A, Murakami A, et al. Mechanisms producing color change in flat early gastric cancers. Endoscopy. 1997;29:366–71.CrossRefPubMed

Mori M, Adachi Y, Kakeji Y, et al. Superficial flat-type early gastric carcinoma of the stomach. Cancer. 1992;69:306–13.CrossRefPubMed

Osawa H, Yamamoto H, Miura Y, et al. Diagnosis of depressed-type early gastric cancer using small-caliber endoscopy with flexible spectral imaging color enhancement. Dig Endosc. 2012;24:231–6.CrossRefPubMed

Fukuda H, Miura Y, Hayashi Y, et al. Linked color imaging technology facilitates early detection of flat gastric cancers. Clin J Gastroenterol. 2015;8:385–9.CrossRefPubMed

Zaman A, Hahn M, Hapke R, et al. A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope. Gastrointest Endosc. 1999;49:279–84.CrossRefPubMed

Birkner B, Fritz N, Schatke W, et al. A prospective randomized comparison of unsedated ultrathin versus standard esophagogastroduodenoscopy in routine outpatient gastroenterology practice: does it work better through the nose? Endoscopy. 2003;35:647–51.CrossRefPubMed

Faulx AL, Catanzaro A, Zyzanski S, et al. Patient tolerance and acceptance of unsedated ultrathin esophagoscopy. Gastrointest Endosc. 2002;55:620–3.CrossRefPubMed

Osawa H, Yamamoto H, Miura Y, et al. Blue laser imaging provides excellent endoscopic images of upper gastrointestinal lesions. Video J Encycl GI Endosc. 2014;1:607–10.CrossRef

Osawa H, Yamamoto H. Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology. Digestive Endoscopy. 2014; 105–15.

10.

Yoshida N, Yagi N, Inada Y, et al. The ability of a novel blue laser imaging system for the diagnosis of colorectal polyps. Dig Endosc. 2014;26:250–8.CrossRefPubMed

11.

Yoshida N, Hisabe T, Inada Y, et al. The ability of a novel blue laser imaging system for the diagnosis of invasion depth of colorectal neoplasms. J Gastroenterol. 2014;49:73–80.CrossRefPubMed

12.

Dohi O, Yagi N, Majima A, et al. Diagnostic ability of magnifying endoscopy with blue laser imaging for early gastric cancer: a prospective study. Gastric Cancer. 2017;20:297–303.CrossRefPubMed

13.

Ikematsu H, Sakamoto T, Togashi K, et al. Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial. Gastrointest Endosc. 2017;86:386–94.CrossRefPubMed

14.

Tomie A, Dohi O, Yagi N, et al. Blue laser imaging-bright improves endoscopic recognition of superficial esophageal squamous cell carcinoma. Gastroenterol Res Pract. 2016; 6140854.

15.

Okada M, Sakamoto H, Takezawa T, et al. Laterally spreading tumor of the rectum delineated with linked color imaging technology. Clin Endosc. 2016;49:207–8.CrossRefPubMedPubMedCentral

16.

Yoshifuku Y, Sanomura Y, Oka S, et al. Evaluation of the visibility of early gastric cancer using linked color imaging and blue laser imaging. BMC Gastroenterol. 2017;8(17):150.CrossRef

17.

Sun X, Dong T, Bi Y, et al. Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study. Sci Rep. 2016;19(6):33473.CrossRef

18.

Ono S, Abiko S, Kato M. Linked color imaging enhances gastric cancer in gastric intestinal metaplasia. Dig Endosc. 2017;29:230–1.CrossRefPubMed

19.

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:E1005–13.CrossRefPubMedPubMedCentral

20.

Osawa H, Yamamoto H, Yamada N, et al. Diagnosis of endoscopic Barrett’s esophagus by transnasal flexible spectral imaging color enhancement. J Gastroenterol. 2009;44:1125–32.CrossRefPubMed

21.

Feldoman M, Friedman LS, Brandt LJ. Sleisenger, fordtran’s gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders; 2006.

22.

Kim N, Park RY, Cho SI, et al. Helicobacter pylori infection and development of gastric cancer in Korea: long-term follow-up. J Clin Gastroenterol. 2008;42:448–54.CrossRefPubMed

23.

Kaminishi M, Yamaguchi H, Nomura S, et al. Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis. Dig Endosc. 2002;14:138–51.CrossRef

24.

Eda A, Osawa H, Yanaka I, et al. Expression of homeobox gene CDX2 precedes that of CDX1 during the progression of intestinal metaplasia. J Gastroenterol. 2002;37:94–100.CrossRefPubMed

25.

Osawa H, Inoue F, Yoshida Y. Inverse relation of serum Helicobacter pylori antibody titres and extent of intestinal metaplasia. J Clin Pathol. 1996;49:112–5.CrossRefPubMedPubMedCentral

26.

Osawa H, Kita H, Satoh K, et al. Aberrant expression of CDX2 in the metaplastic epithelium and inflammatory mucosa of the gallbladder. Am J Surg Pathol. 2004;28:1253–4.CrossRefPubMed

27.

Mutlu-Sagesen L, Ergun G, Ozkan Y, et al. Color stability of different denture teeth materials: an in vitro study. J Oral Sci. 2001;43:193–205.CrossRefPubMed

28.

Kim SH, Lee YK, Lim BS, et al. Difference in color and color parameters between dental porcelain and porcelain-repairing resin composite. J Biomed Mater Res B Appl Biomater. 2006;76:149–54.CrossRefPubMed

29.

Iwami Y, Hayashi N, Takeshige F, et al. Relationship between the color of carious dentin with varying lesion activity, and bacterial detection. J Dent. 2008;36:143–51.CrossRefPubMed

30.

Nakamura K, Sugano H, Takagi K. Carcinoma of the stomach in incipient phase, its histogenesis and histological appearances. Gann. 1968;59:251–8.PubMed

31.

Matsukura N, Suzuki K, Kawachi T, et al. Distribution of marker enzymes and mucin in intestinal metaplasia in human stomach and relation to complete and incomplete types of intestinal metaplasia to minute gastric carcinomas. J Natl Cancer Inst. 1980;65:231–40.PubMed

32.

Kohli Y, Pfeiffer CJ, Kutty KP, et al. Endoscopic diagnosis of intestinal metaplasia in Canada and Japan. J Clin Gastroenterol. 1981;3(Suppl 1):29–33.CrossRefPubMed

Title: Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia
Authors: Hisashi Fukuda
Yoshimasa Miura
Hiroyuki Osawa
Takahito Takezawa
Yuji Ino
Masahiro Okada
Tsevelnorov Khurelbaatar
Alan Kawarai Lefor
Hironori Yamamoto
Publication date: 01-05-2019
Publisher: Springer Japan
Published in: Journal of Gastroenterology / Issue 5/2019
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI: https://doi.org/10.1007/s00535-018-1515-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Linked color imaging can enhance recognition of early gastric cancer by high color contrast to surrounding gastric intestinal metaplasia

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2019

Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial

NS5A-P32 deletion as a factor involved in virologic failure in patients receiving glecaprevir and pibrentasvir

Metachronous gastric cancer risk after endoscopic resection of early gastric cancer and H. pylori status

Correction to: Proton pump inhibitor monotherapy is effective to attenuate dyspepsia symptoms associated with gastroesophageal reflux disease: a multicenter prospective observational study

Independent and additive effects of PNPLA3 and TM6SF2 polymorphisms on the development of non-B, non-C hepatocellular carcinoma

Meaningless comparison of resection depth between cold snare polypectomy and endoscopic mucosal resection

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page