Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
Surg Endosc. 2022 Nov;36(11):8316-8325. doi: 10.1007/s00464-022-09280-0. Epub 2022 May 4.
Early gastric cancer (EGC) lesions are often subtle and endoscopically poorly visible. The aim of this study is to evaluate the additive effect of linked color imaging (LCI) next to white-light endoscopy (WLE) for identification of EGC, when assessed by expert and non-expert endoscopists.
Forty EGC cases were visualized in corresponding WLE and LCI images. Endoscopists evaluated the cases in 3 assessment phases: Phase 1: WLE images only; Phase 2: LCI images only; Phase 3: WLE and LCI images side-to-side. First, 3 expert endoscopists delineated all cases. A high level of agreement between the expert delineations corresponded with a high AND/OR ratio. Subsequently, 62 non-experts indicated their preferred biopsy location. Outcomes of the study are as follows: (1) difference in expert AND/OR ratio; (2) accuracy of biopsy placement by non-expert endoscopists; and (3) preference of imaging modality by non-expert endoscopists.
Quantitative agreement between experts increased significantly when LCI was available (0.58 vs. 0.46, p = 0.007). This increase was more apparent for the more challenging cases (0.21 vs. 0.47, p < 0.001). Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, p < 0.001). Again this increase was more profound for the more challenging cases (70.4% vs. 83.4%, p < 0.001). Non-experts indicated to prefer LCI over WLE.
The addition of LCI next to WLE improves visualization of EGC. Experts reach higher consensus on discrimination between neoplasia and inflammation when using LCI. Non-experts improve their targeted biopsy placement with the use of LCI. LCI therefore appears to be a useful tool for identification of EGC.
早期胃癌（EGC）病变常较为隐匿，内镜下不易发现。本研究旨在评估窄带成像（LCI）与白光内镜（WLE）联合应用对 EGC 识别的附加作用，评估者包括专家和非专家内镜医生。
40 例 EGC 患者的 WLE 和 LCI 图像均用于评估。内镜医生在 3 个评估阶段对病例进行评估：阶段 1：仅 WLE 图像；阶段 2：仅 LCI 图像；阶段 3：并排显示 WLE 和 LCI 图像。首先，3 位专家内镜医生对所有病例进行勾画。专家勾画结果一致性高对应着高 AND/OR 比值。随后，62 名非专家内镜医生指出他们认为的最佳活检位置。本研究的结果包括：（1）专家 AND/OR 比值的差异；（2）非专家内镜医生活检位置的准确性；（3）非专家内镜医生对成像方式的偏好。
当有 LCI 时，专家间的定量一致性显著增加（0.58 比 0.46，p=0.007）。对于更具挑战性的病例，这种增加更为明显（0.21 比 0.47，p<0.001）。非专家使用 LCI 时，活检标记的准确性更高（82.3%比 87.2%，p<0.001）。对于更具挑战性的病例，这种增加更为显著（70.4%比 83.4%，p<0.001）。非专家表示更喜欢 LCI 而不是 WLE。
WLE 旁添加 LCI 可改善 EGC 的可视化效果。专家在使用 LCI 时对肿瘤和炎症的鉴别有更高的共识。非专家使用 LCI 可提高靶向活检的准确性。因此，LCI 似乎是识别 EGC 的有用工具。
