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. 2021 Aug 24;2(1):e46.
doi: 10.1002/deo2.46. eCollection 2022 Apr.

Visibility of early gastric cancer in texture and color enhancement imaging

Seiichiro Abe  1 , Takayuki Yamazaki  1 , Izumi Tanimoto Hisada  1 , Mai Ego Makiguchi  1 , Shigetaka Yoshinaga  1 , Tomoya Sato  2 , Satoru Nonaka  1 , Haruhisa Suzuki  1 , Ichiro Oda  1   3 , Yutaka Saito  1
Affiliations

Visibility of early gastric cancer in texture and color enhancement imaging

Seiichiro Abe et al. DEN Open. .

Abstract

Objective: There are little data regarding the efficacy of texture and color enhancement imaging (TXI) for early gastric cancer (EGC) diagnosis. This study aimed to compare the color difference and visibility of EGC between white light imaging (WLI) and TXI.

Methods: This study included 20 EGCs of 18 patients undergoing endoscopic submucosal dissection. Still images of EGC in WLI, TXI mode 1 (with color enhancement), and TXI mode 2 (without color enhancement), which were consistent in distance, angle, and air insufflation, were constructed by computer simulation. The center of the lesion, eight equal peripheral points 5 mm outside the lesion, and eight inner points two-thirds of the distance from peripheral points to the EGC lesion center were annotated. Mean color differences (ΔE) of the area between peripheral and inner points per lesion in WLI, TXI mode 1, and TXI mode 2 were analyzed. In addition, four endoscopists independently scored the visibility of EGC images of TXI mode 1 and 2 compared with WLI.

Results: Clinicopathological characteristics were as follows: 0-IIa/0-IIb/0-IIc/0-IIa+IIc = 6/1/11/2, reddish/pale = 10/10, differentiated/undifferentiated = 18/2, median tumor size = 13.5 mm. Mean ΔE ± SD = WLI/TXI mode1/TXI mode2 = 10.3 ± 4.7, 15.5 ± 7.8, and 12.7 ± 6.1, respectively. Mean ΔE was significantly higher in TXI mode 1 than in WLI. Visibility (improved/no change/decreased) was 7/13/0 and 4/16/0 in TXI mode 1 and 2, respectively. The visibility was significantly more commonly improved in the macroscopic type 0-IIc or 0-IIb than in 0-IIa or IIa+IIc in TXI mode 1.

Conclusions: TXI could improve the visibility of EGC compared with WLI.

Keywords: early gastric cancer; image enhanced endoscopy; texture and color enhancement imaging; visibility.

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Conflict of interest statement

The author Seiichiro Abe was supported by a research grant from Olympus Medical Systems (C2020‐036). The authors Seiichiro Abe and Yutaka Saito received honoraria for lectures from Olympus Medical Systems. The author Seiichiro Abe is an associate editor of DEN Open.

Figures

FIGURE 1
FIGURE 1
Concept of texture and color enhancement imaging (TXI). A white light image is decomposed into the detail layer and the base layer. Texture of an image such as subtle surface elevation or depression is strengthened by enhancing the detail layer. The partial brightness control in the image can be achieved by processing techniques to adjust the brightness of the base layer. The enhanced detail layer and the corrected base layer are recombined to produce one of the TXI outputs. In addition, the color tone of that output is highly enhanced, which is designed to exaggerate the color difference, especially between red and white colors. There are two modes in TXI: mode 1 is one which outputs with color enhancement. The other is mode 2 which outputs without color enhancement, similar to the white‐light color tones
FIGURE 2
FIGURE 2
Annotation of lateral margin, peripheral, and inner points on EGC images for color difference analysis. (a) A reddish elevated lesion is seen in the anterior wall of the antrum. (b) An expert endoscopist defined the region of interest and delineated the margin of EGC on the WLI image. The endoscopist manually annotated the center of the lesion, eight equal peripheral non‐cancerous points 5 mm outside the lesion (proximal, distal, anterior, posterior, and four midpoints between the two points). (c) Eight innerpoints (green spots) were annotated two‐thirds of the distance from peripheral points to the EGC lesion center. Blue spots indicate the peripheral points. (d) The peripheral and inner points were similarly annotated on the image of TXI mode 1 with the same angle, distance, and air insufflation. (e) The peripheral and inner points were similarly annotated on the image of TXI mode 2 with the same angle, distance, and air insufflation
FIGURE 3
FIGURE 3
The patient flow of this study. Among 129 EGCs in 120 patients undergoing ESD, a total of 20 EGCs in 18 patients were video‐recorded and evaluated in this study. One hundred two patients without raw image data were excluded from analysis
FIGURE 4
FIGURE 4
A representative case of EGC with improved visibility. (a) WLI showed a slightly pale lesion in the anterior wall of the antrum. The mean ΔE was 4.34. (b) TXI mode 1 demonstrated enhancement of the depression and pale color with a mean ΔE of 7.18. The visibility was scored as improved, with a total visibility score of 6. (c) TXI mode 2 demonstrated enhancement of the depression with a mean ΔE of 6.04. The visibility was scored as improved, with a total visibility score of 7
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