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Linked color imaging bests conventional imaging for upper GI cancer detection

Annals of Internal Medicine
Reuters Health - 19/10/2020 - Linked color imaging (LCI), an image-enhanced endoscopy technique that enables users to recognize slight differences in mucosal color, was more effective than conventional white light imaging (WLI) in detecting neoplastic lesions in the upper gastrointestinal (GI) tract in a randomized controlled trial in Japan.

"The guideline for endoscopic GI screening should be changed," Dr. Mototsugu Kato of National Hospital Organization Hakodate National Hospital in Japan told Reuters Health by email. "LCI reduces (the possibility of) missed neoplastic lesions."

As reported in Annals of Internal Medicine, Dr. Kato and colleagues studied 1,502 patients with known previous or current GI tract cancer, considered high-risk populations for upper GI tract tumors. Participants were randomized to WLI followed by LCI (WLI group) or LCI followed by WLI (LCI group).

Demographic variables were similar in both groups: about 40% were under age 70; 77% were men; 12% had a history of surgery; 16% had current cancer; and 11.7% had a history of radiation therapy.

The primary outcome was a diagnosis of one or more neoplastic lesion in the pharynx, esophagus, or stomach in the first examination. The secondary outcome was one or more neoplastic lesion overlooked in the first examination.

The percentage of patients with one or more neoplastic lesion diagnosed in the first examination was higher with LCI than with WLI (8% vs. 4.8%; risk ratio, 1.67). Pharyngeal neoplasms accounted for 5.4% of the lesions detected in the WLI group and 10.6% in the LCI group. The proportion of lesions strongly suspected of being malignant was 54.1% in the WLI group and 86.4% in the LCI group.

The proportion with overlooked neoplasms was higher with WLI than with LCI (3.5% vs. 0.67%; RR, 0.19).

Fifty-eight endoscopists who had performed at least 20 endoscopic procedures using LCI participated in the study, performing a median of 15 endoscopies. Twenty-three detected tumors, with three detecting tumors in 15 or more patients.

Nearly all of the endoscopists performed endoscopies in patients in both groups. No trends were observed in the frequencies of lesion detection among the endoscopists. However, endoscopists were not blinded, which is noted as a study limitation.

Dr. Nikhil Kumta, Director of Surgical and Bariatric Endoscopy and Director, Sinai Laboratory for Innovation and Developmental Endoscopy at the Icahn School of Medicine at Mt. Sinai in New York City, commented in an email to Reuters Health.

"LCI is promising," he said, "though...there are multiple other available methods of chromoendoscopy to increase lesion identification, including conventional spray dye and other electronic-/equipment-based modalities such as narrow band imaging, blue laser imaging, and flexible spectral imaging colon enhancement, to name a few."

"The results show that LCI can detect neoplastic lesions in the upper GI tract 1.67 times more frequently than WLI," he said. "This is not a surprising finding, as other methods of image enhancement have also demonstrated increased detection compared to standard white light endoscopy. More studies are needed to determine which type of image enhancement has the highest increase in diagnostic yield/detection of neoplastic lesions."

For example, he noted, "A randomized trial that compares LCI to other forms of chromoendoscopy would be helpful, instead of the comparison to white light endoscopy."

"Cost is an issue if endoscopy units do not already have Fujifilm scopes," he said. "In addition to the scope themselves, other ancillary equipment such as compatible scope processors would be necessary."

"Further," he added, "This study was conducted in Japan, where there are different incidence rates of esophageal and gastric cancer compared to the United States."

The study was funded by the Fujifilm Corporation. Dr. Kato has received scholarship grants from the company. The LCI systems used in the study are available globally through Fujifilm.

By Marilynn Larkin

SOURCE: https://bit.ly/3m0d2Mo Annals of Internal Medicine, online October 19, 2020.

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