Najah Haythem, Lo Dico Réa, Dohan Anthony, Marry Lucy, Eveno Clarisse, Pocard Marc
Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France.
Surg Endosc. 2017 Feb;31(2):743-751. doi: 10.1007/s00464-016-5028-1. Epub 2016 Jun 20.
Detection of an incipient peritoneal carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. Fujinon Intelligent Chromo Endoscopy (FICE) is a spectral image processing technology that enhances the contrast of the target tissue. The aim of this study is to investigate the usefulness of FICE system during peritoneal endoscopy and to establish the optimal FICE preset(s) for peritoneal exploration and PC detection.
A total of 561 images corresponding to 51 different areas of PC nodules and normal peritoneum were recorded during peritoneal endoscopies (For each area, one white light endoscopy (WLE) image and 10 FICE images). Three groups of 5 evaluators each: senior surgeons, surgical residents and medical students assessed these images. In a first questionnaire, the evaluators gave a score ranging from 1 to 10 to each image, and the three best FICE channels were determined. In a second questionnaire, five criteria were studied specifically: contrast, brightness, vascular architecture, differentiation between organs and detection of PC. The evaluators ranked the WLE and the three best FICE channel images according to these criteria.
The three best FICE channels were channels 6, 2 and 9 with mean scores of 6.21 ± 1.59, 6.17 ± 1.48 and 6.06 ± 1.52, respectively. FICE Channel 2 was superior to WLE and other FICE channels, in terms of contrast (p < 10), visualization of vascular architecture (p < 10), differentiation between organs (p < 10) and detection of PC (p < 10); and ranked first in 38.8, 41.5, 31 and 46.9 % of the cases, respectively.
FICE system provides adequate illumination of the abdominal cavity and a unique contrast that enhances the vascular architecture. FICE Channel 2 is the optimal channel for peritoneal exploration and could be a useful tool for the diagnosis of PC during peritoneal explorations.
早期腹膜癌转移（PC）的检测仍然具有挑战性，迫切需要技术改进以实现对该疾病的早期诊断和治疗。富士能智能分光电子内镜检查（FICE）是一种光谱图像处理技术，可增强目标组织的对比度。本研究旨在探讨FICE系统在腹膜内镜检查中的应用价值，并确定用于腹膜探查和PC检测的最佳FICE预设参数。
在腹膜内镜检查期间，共记录了对应于51个不同PC结节区域和正常腹膜区域的561张图像（每个区域有1张白光内镜检查（WLE）图像和10张FICE图像）。三组评估人员，每组5人，分别为资深外科医生、外科住院医师和医学生，对这些图像进行评估。在第一份问卷中，评估人员对每张图像给出1至10分的评分，并确定三个最佳的FICE通道。在第二份问卷中，具体研究了五个标准：对比度、亮度、血管结构、器官区分以及PC的检测。评估人员根据这些标准对WLE图像和三个最佳FICE通道图像进行排序。
三个最佳的FICE通道分别为通道6、2和9，平均得分分别为6.21±1.59、6.17±1.48和6.06±1.52。在对比度（p<0.01）、血管结构可视化（p<0.01）、器官区分（p<0.01）和PC检测（p<0.01）方面，FICE通道2优于WLE和其他FICE通道；在38.8%、41.5%、31%和46.9%的病例中分别排名第一。
FICE系统可为腹腔提供充足照明，并提供独特的对比度，增强血管结构。FICE通道2是腹膜探查的最佳通道，可能是腹膜探查期间诊断PC的有用工具。
