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Toyoshima O, Nishizawa T, Hata K. Topic highlight on texture and color enhancement imaging in gastrointestinal diseases. World J Gastroenterol 2024; 30:1934-1940. [DOI: 10.3748/wjg.v30.i14.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/03/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Olympus Corporation developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting. A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate (ADR) and the mean number of adenomas per procedure (MAP) of TXI compared with those of white-light imaging (WLI) observation (58.7% vs 42.7%, adjusted relative risk 1.35, 95%CI: 1.17-1.56; 1.36 vs 0.89, adjusted incident risk ratio 1.48, 95%CI: 1.22-1.80, respectively). A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI (1.5 vs 1.0, adjusted odds ratio 1.4, 95%CI: 1.2-1.6; 58.2% vs 46.8%, 1.5, 1.0-2.3, respectively). A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure (0.29 vs 0.30, difference for non-inferiority -0.01, 95%CI: -0.10 to 0.08). A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis. A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI (0.71% vs 0.29%). A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI (69.2% vs 52.5% and 85.3% vs 78.7%, respectively). In conclusion, TXI can improve gastrointestinal lesion detection and qualitative diagnosis. Therefore, further studies on the efficacy of TXI in clinical practice are required.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Keisuke Hata
- Department of Gastroenterology, Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo 103-0022, Japan
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Qi ZP, Xu EP, He DL, Wang Y, Chen BS, Dong XS, Shi Q, Cai SL, Guo Q, Li N, Li X, Huang HY, Li B, Sun D, Xu JG, Chen ZH, Yalikong A, Liu JY, Lv ZT, Xu JM, Zhou PH, Zhong YS. Efficacy of image-enhanced endoscopy for colorectal adenoma detection: A multicenter, randomized trial. World J Gastrointest Oncol 2023; 15:878-891. [PMID: 37275449 PMCID: PMC10237030 DOI: 10.4251/wjgo.v15.i5.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer. However, whether image-enhanced endoscopy (IEE) further improves the adenoma detection rate (ADR) is controversial.
AIM To compare IEE with white-light imaging (WLI) endoscopy for the detection and identification of colorectal adenoma.
METHODS This was a multicenter, randomized, controlled trial. Participants were enrolled between September 2019 to April 2021 from 4 hospital in China. Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal (n = 2113) or a WLI group with WLI on both entry and withdrawal (n = 2098). The primary outcome was the ADR. The secondary endpoints were the polyp detection rate (PDR), adenomas per colonoscopy, adenomas per positive colonoscopy, and factors related to adenoma detection.
RESULTS A total of 4211 patients (966 adenomas) were included in the analysis (mean age, 56.7 years, 47.1% male). There were 2113 patients (508 adenomas) in the IEE group and 2098 patients (458 adenomas) in the WLI group. The ADR in two group were not significantly different [24.0% vs 21.8%, 1.10, 95% confidence interval (CI): 0.99-1.23, P = 0.09]. The PDR was higher with IEE group (41.7%) than with WLI group (36.1%, 1.16, 95%CI: 1.07-1.25, P = 0.01). Differences in mean withdrawal time (7.90 ± 3.42 min vs 7.85 ± 3.47 min, P = 0.30) and adenomas per colonoscopy (0.33 ± 0.68 vs 0.28 ± 0.62, P = 0.06) were not significant. Subgroup analysis found that with narrow-band imaging (NBI), between-group differences in the ADR, were not significant (23.7% vs 21.8%, 1.09, 95%CI: 0.97-1.22, P = 0.15), but were greater with linked color imaging (30.9% vs 21.8%, 1.42, 95%CI: 1.04-1.93, P = 0.04). the second-generation NBI (2G-NBI) had an advantage of ADR than both WLI and the first-generation NBI (27.0% vs 21.8%, P = 0.01; 27.0% vs 21.2.0%, P = 0.01).
CONCLUSION This prospective study confirmed that, among Chinese, IEE didn’t increase the ADR compared with WLI, but 2G-NBI increase the ADR.
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Affiliation(s)
- Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - En-Pan Xu
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Dong-Li He
- Endoscopy Center, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Yan Wang
- Endoscopy Center, Traditional Chinese Medical Hospital, Rongcheng 264300, Shandong Province, China
| | - Bai-Sheng Chen
- Department of Endoscopy Center, Xiamen Branch of Affiliated Zhongshan Hospital of Fudan University, Xiamen 361000, Fujian Province, China
| | - Xue-Si Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Qi Guo
- Endoscopy Center, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
| | - Xing Li
- Department of Gastroenterology, Pingxiang People’s Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Hai-Yan Huang
- Department of Clinical Medicine, Xiaogang Hospital, Ningbo 315000, Zhejiang Province, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Di Sun
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Jian-Guang Xu
- Endoscopy Center, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
| | - Zhang-Han Chen
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Ayimukedisi Yalikong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Jin-Yi Liu
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Zhen-Tao Lv
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Jian-Min Xu
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200030, China
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Kojima T, Yao K, Ohtsu K, Kuan C, Tanabe H, Imamura K, Kanemitsu T, Miyaoka M, Nagahama T, Ueki T, Iwashita A. A comparative study of demarcation line diagnostic performance between non-magnifying observation with white light and non-magnifying observation with narrow-band light for early gastric cancer. Gastric Cancer 2022; 25:761-9. [PMID: 35523984 DOI: 10.1007/s10120-022-01299-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS With the improvement in endoscopic equipment functions, narrow-band imaging (NBI) for endoscopic observation of the stomach, which is an organ with a large lumen, is now feasible. Studies evaluating the NBI utility without magnifying endoscopy to diagnose the invasion extent for the demarcation line identification in early gastric cancer have not been reported. This study aimed to investigate the demarcation line diagnostic performance of NBI in early gastric cancer compared to that of white-light imaging (WLI) using prospectively collected consecutive specimens from early gastric cancer patients. METHODS Thirty consecutive lesions were collected from patients who underwent endoscopic submucosal dissection for early gastric cancer. Next, 30 NBI and 30 WLI images, each with the same degree of gastric wall extension, angle, and layout for one lesion, were selected, and a total of 60 images were prepared for testing. The early gastric cancer invasion ranges in the endoscopic images was plotted using the web-developed software, and 264 independent endoscopists, unaware of the diagnosis, performed the web tests, with the concordance rates between the ranges of responses. After estimating the actual early gastric cancer invasion ranges, the NBI and WLI results were compared. RESULTS The concordance rates for NBI and WLI images were 43.1% (95% confidence interval [CI] 42.5-43.7%) and 37.2% (95% CI 36.6-37.7%), respectively, showing that the concordance rate for NBI was significantly higher than that for WLI. CONCLUSION This study suggested that NBI was more useful for identifying demarcation lines than WLI.
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Li B, Cai SL, Tan WM, Li JC, Yalikong A, Feng XS, Yu HH, Lu PX, Feng Z, Yao LQ, Zhou PH, Yan B, Zhong YS. Comparative study on artificial intelligence systems for detecting early esophageal squamous cell carcinoma between narrow-band and white-light imaging. World J Gastroenterol 2021; 27:281-293. [PMID: 33519142 PMCID: PMC7814365 DOI: 10.3748/wjg.v27.i3.281] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/05/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-magnifying endoscopy with narrow-band imaging (NM-NBI) has been frequently used in routine screening of esophagus squamous cell carcinoma (ESCC). The performance of NBI for screening of early ESCC is, however, significantly affected by operator experience. Artificial intelligence may be a unique approach to compensate for the lack of operator experience.
AIM To construct a computer-aided detection (CAD) system for application in NM-NBI to identify early ESCC and to compare it with our previously reported CAD system with endoscopic white-light imaging (WLI).
METHODS A total of 2167 abnormal NM-NBI images of early ESCC and 2568 normal images were collected from three institutions (Zhongshan Hospital of Fudan University, Xuhui Hospital, and Kiang Wu Hospital) as the training dataset, and 316 pairs of images, each pair including images obtained by WLI and NBI (same part), were collected for validation. Twenty endoscopists participated in this study to review the validation images with or without the assistance of the CAD systems. The diagnostic results of the two CAD systems and improvement in diagnostic efficacy of endoscopists were compared in terms of sensitivity, specificity, accuracy, positive predictive value, and negative predictive value.
RESULTS The area under receiver operating characteristic curve for CAD-NBI was 0.9761. For the validation dataset, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CAD-NBI were 91.0%, 96.7%, 94.3%, 95.3%, and 93.6%, respectively, while those of CAD-WLI were 98.5%, 83.1%, 89.5%, 80.8%, and 98.7%, respectively. CAD-NBI showed superior accuracy and specificity than CAD-WLI (P = 0.028 and P ≤ 0.001, respectively), while CAD-WLI had higher sensitivity than CAD-NBI (P = 0.006). By using both CAD-WLI and CAD-NBI, the endoscopists could improve their diagnostic efficacy to the highest level, with accuracy, sensitivity, and specificity of 94.9%, 92.4%, and 96.7%, respectively.
CONCLUSION The CAD-NBI system for screening early ESCC has higher accuracy and specificity than CAD-WLI. Endoscopists can achieve the best diagnostic efficacy using both CAD-WLI and CAD-NBI.
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Affiliation(s)
- Bing Li
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Shi-Lun Cai
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Wei-Min Tan
- School of Computer Science, Fudan University, Shanghai 200433, China
| | - Ji-Chun Li
- School of Computer Science, Fudan University, Shanghai 200433, China
| | - Ayimukedisi Yalikong
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Xiao-Shuang Feng
- Clinical Statistical Center, Shanghai Cancer Center of Fudan University, Shanghai 200032, China
| | - Hon-Ho Yu
- Department of Gastroenterology, Kiang Wu Hospital, Macau SAR 999078, China
| | - Pin-Xiang Lu
- Department of Endoscopy Center, Xuhui Hospital, Zhongshan Hospital of Fudan University, Shanghai 200031, China
| | - Zhen Feng
- Department of Endoscopy Center, Xuhui Hospital, Zhongshan Hospital of Fudan University, Shanghai 200031, China
| | - Li-Qing Yao
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ping-Hong Zhou
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Bo Yan
- School of Computer Science, Fudan University, Shanghai 200433, China
| | - Yun-Shi Zhong
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
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