Department of Gastroenterology, Shandong University Qilu Hospital, Jinan 250012, Shandong Province, China.
World J Gastroenterol. 2013 Jul 14;19(26):4221-7. doi: 10.3748/wjg.v19.i26.4221.
To evaluate the feasibility of a new computed virtual chromoendoscopy (CVC) device (M i-scan) in the diagnosis of gastric neoplasia.
Patients with superficial lesions no larger than 1.0 cm found during high definition endoscopy were included. Those with advanced or obviously protruded or depressed lesions, lesions larger than 1.0 cm and/or lesions which were not amenable to observation by zoom function were excluded. The endoscopist was required to give the real-time descriptions of surface pit patterns of the lesions, based on surface pattern classification of enhanced magnification endoscopy. According to previous reports, types I-III represent non-neoplastic lesions, and types IV-V represent neoplastic lesions. Diagnosis with M i-scan and biopsy was performed before histopathological diagnosis. Magnified images of gastric lesions with and without enhancement were collected for further analysis. The diagnostic yield of real-time M i-scan and effects on magnification image quality by tone enhancement (TE), surface enhancement (SE) and color enhancement (CE) were calculated. The selected images were sent to another endoscopist. The endoscopist rated the image quality of each lesion at 3 levels. Ratings of image quality were based on visualization of pit pattern, vessel and demarcation line.
One hundred and eighty-three patients were recruited. Five patients were excluded for advanced gastric lesions, 1 patient was excluded for poor preparation and 2 patients were excluded for superficial lesions larger than 1.0 cm; 132 patients were excluded for no lesions found by high definition endoscopy. In the end, 43 patients with 43 lesions were included. Histopathology revealed 10 inflammation, 14 atrophy, 10 metaplasia, 1 low grade dysplasia (LGD), 5 high grade dysplasia (HGD) and 3 cancers. For 7 lesions classified into type I, histopathology revealed 6 atrophy and 1 metaplasia; for 10 lesions classified into type II, histopathology revealed 2 inflammation, 7 atrophy and 1 metaplasia; for 10 lesions classified into type III, histopathology revealed 1 inflammation, 8 metaplasia and 1 LGD; for 9 lesions classified into type IV, histopathology revealed 4 inflammation, 1 atrophy and 4 HGD; for 7 lesions classified into type V, histopathology revealed 3 inflammation, 1 HGD and 3 cancers. A total of 172 still images, including 43 images by white light (MWL) and 129 images by M i-scan (43 with TE, 43 with SE and 43 with CE), were selected and sent to the endoscopist who did the analysis. General image quality of M i-scan with TE and SE was significantly better than that of MWL (TE, 4.55 ± 1.07; SE, 4.30 ± 1.02; MWL, 3.25 ± 0.99; P < 0.001). Visualization of pit pattern was significantly improved by M i-scan with SE (1.93 ± 0.25 vs 1.50 ± 0.50, P < 0.001). Microvessel visualization was significantly improved by M i-scan with TE (1.23 ± 0.78 vs 0.76 ± 0.73, P < 0.001). Demarcation line visualization was improved by M i-scan with both TE and SE (TE, 1.75 ± 0.52; SE, 1.56 ± 0.59; MWL, 0.98 ± 0.44; P < 0.001). M i-scan with CE did not show any significant improvements of image quality in general or in the 3 key parameters. Although M i-scan with TE and SE slightly increased the diagnostic yield of MWL, there was no significant difference (P > 0.1).
Although digital enhancement improves the image quality of magnification endoscopy, its value in improving the diagnostic yield seems to be limited.
评估新型计算机虚拟 chromoendoscopy（CVC）设备（M i-scan）在胃肿瘤诊断中的可行性。
纳入高清晰度内镜检查发现的直径不超过 1.0cm 的表浅病变患者。排除进展期或明显隆起或凹陷病变、直径大于 1.0cm 以及/或不适合变焦功能观察的病变患者。要求内镜医生根据增强放大内镜的表面模式分类，对病变的表面 pit 模式进行实时描述。根据以往的报道，I-III 型代表非肿瘤性病变，IV-V 型代表肿瘤性病变。在组织病理学诊断前，使用 M i-scan 进行诊断和活检。收集胃病变的放大图像（增强和未增强）进行进一步分析。计算实时 M i-scan 的诊断产量以及色调增强（TE）、表面增强（SE）和颜色增强（CE）对放大图像质量的影响。选择的图像发送给另一位内镜医生。该内镜医生对每个病变的图像质量进行 3 级评分。图像质量评分基于 pit 模式、血管和分界线的可视化。
共纳入 183 例患者。5 例因进展期胃病变被排除，1 例因准备不佳被排除，2 例因病变直径大于 1.0cm 被排除，132 例因高清晰度内镜检查未发现病变而被排除。最终，43 例患者共 43 个病变纳入研究。组织病理学显示 10 个炎症，14 个萎缩，10 个化生，1 个低级别上皮内瘤变（LGD），5 个高级别上皮内瘤变（HGD）和 3 个癌症。7 个 I 型病变中有 6 个为萎缩，1 个为化生；10 个 II 型病变中有 2 个为炎症，7 个为萎缩，1 个为化生；10 个 III 型病变中有 1 个为炎症，8 个为化生，1 个为 LGD；9 个 IV 型病变中有 4 个为炎症，1 个为萎缩，4 个为 HGD；7 个 V 型病变中有 3 个为炎症，1 个为 HGD，3 个为癌症。共选择 172 张静态图像，包括 43 张白光（MWL）图像和 129 张 M i-scan 图像（43 张有 TE，43 张有 SE，43 张有 CE），并发送给进行分析的内镜医生。M i-scan 与 TE 和 SE 的总体图像质量明显优于 MWL（TE，4.55±1.07；SE，4.30±1.02；MWL，3.25±0.99；P<0.001）。SE 增强的 M i-scan 对 pit 模式的可视化有明显改善（1.93±0.25 比 1.50±0.50，P<0.001）。TE 增强的 M i-scan 对微血管可视化有明显改善（1.23±0.78 比 0.76±0.73，P<0.001）。TE 和 SE 增强的 M i-scan 都改善了分界线的可视化（TE，1.75±0.52；SE，1.56±0.59；MWL，0.98±0.44；P<0.001）。CE 增强的 M i-scan 在总体和 3 个关键参数上均未显示出任何明显的图像质量改善。尽管 M i-scan 与 TE 和 SE 略微提高了 MWL 的诊断产量，但无统计学差异（P>0.1）。
尽管数字增强提高了放大内镜的图像质量，但它在提高诊断产量方面的价值似乎有限。
