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Multicenter Study
. 2024 Nov 5;19(11):e0312385.
doi: 10.1371/journal.pone.0312385. eCollection 2024.

Analysis of clinicopathological factors associate with the visibility of early gastric cancer in endoscopic examination and usefulness of linked color imaging: A multicenter prospective study

Kensuke Fukuda  1 , Kazuhiro Mizukami  1 , Daisuke Yamaguch  2 , Yuichiro Tanaka  2 , Kazutoshi Hashiguchi  3 , Takashi Akutagawa  4 , Ryo Shimoda  4 , Sho Suzuki  5 , Tadashi Miike  5 , Yorinobu Sumida  6 , Hidehito Maeda  7 , Fumisato Sasaki  7 , Ryosuke Gushima  8 , Hideaki Miyamoto  8 , Keiichi Hashiguchi  9 , Naoyuki Yamaguchi  9 , Tetsuya Ohira  10 , Tetsu Kinjo  10 , Ken Ohnita  11 , Tomohiko Moriyama  12 , Kensei Ohtsu  13 , Akira Aso  14 , Ryo Ogawa  1 , Tetsuya Ueo  15 , Masahide Fukuda  1
Affiliations
Multicenter Study

Analysis of clinicopathological factors associate with the visibility of early gastric cancer in endoscopic examination and usefulness of linked color imaging: A multicenter prospective study

Kensuke Fukuda et al. PLoS One. .

Erratum in

Abstract

Background: This study investigated clinicopathological factors associated with the visibility of early gastric cancer and the efficacy of linked color imaging.

Methods: Patients with early gastric cancer who underwent endoscopic treatment between April 2021 and July 2022 were enrolled. All cases underwent white light imaging and linked color imaging. Three experts evaluated lesion visibility using a visual analog scale. A mean score ≥3 on white light imaging was defined as "good visibility", and <3 as "poor visibility". We extracted patient information and endoscopic and pathological data for the lesion and background mucosa, analyzed factors associated with the visibility of early gastric cancer, and compared visibility between white light imaging and linked color imaging.

Results: Ninety-seven lesions were analyzed, with good visibility in 49 and poor visibility in 48. Multivariate analysis revealed small lesion size (odds ratio 1.89) and presence of endoscopic intestinal metaplasia (odds ratio 0.49) as significantly associated with the poor visibility of early gastric cancer. Mean visibility score was significantly higher for linked color imaging (P<0.001). Mean score for linked color imaging was significantly higher in the poor visibility group (P<0.001), but not significantly different in the good visibility group (P = 0.292). Mean score was significantly higher with linked color imaging in cases with endoscopic intestinal metaplasia (P = 0.0496) and lesions <20 mm in diameter (<10 mm, P = 0.002; 10-20 mm, P = 0.004).

Conclusions: Lesion size and endoscopic intestinal metaplasia are associated with the visibility of early gastric cancer in white light imaging. Linked color imaging improves visibility of gastric cancer with these factors.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Representative images of early gastric cancer with mean visibility score of 1.0, 3.0, 5.0 on WLI.
(a) Type 0-IIb early gastric cancer located on posterior wall of gastric angle (yellow triangle). Mean visibility score of this lesion was 1.0. (b) Type 0-IIc early gastric cancer located on lesser curvature of the upper gastric body (yellow triangle). Mean visibility score of this lesion was 3.0. (c) Type 0-IIc early gastric cancer located on greater curvature of gastric antrum (yellow triangle). Mean visibility score of this lesion was 5.0.
Fig 2
Fig 2. Study flowchart.
Good visibility, lesions with mean visibility score ≥3 on WLI; poor visibility, lesions with mean visibility score <3 on WLI.
Fig 3
Fig 3
Comparison of mean visibility score between WLI and LCI. WLI, White light imaging; LCI, Linked color imaging; *, statistically significant.
Fig 4
Fig 4. Representative images of early gastric cancer in which the visibility was classified as poor visibility on WLI but improved to good visibility on LCI.
Type 0-Ⅱc early gastric cancer, 9 mm in size, located on posterior wall of the upper gastric body (yellow triangle). The mean visibility score on WLI was 1.7, which was classified as poor visibility (a), but the mean visibility score on LCI improved to 3.0 (b). WLI, White light imaging; LCI, Linked color imaging.
Fig 5
Fig 5. Comparison of mean visibility score of WLI and LCI in good visibility lesions and poor visibility lesions.
WLI, White light imaging; LCI, Linked color imaging; good visibility, lesions with mean visibility score ≥3 on WLI; poor visibility, lesions with mean visibility score <3 on WLI; *, statistically significant.
Fig 6
Fig 6. Comparison of visibility score of WLI and LCI by presence or absence of intestinal metaplasia and lesion size.
(a), (b) Comparison of visibility score of WLI and LCI by presence or absence of intestinal metaplasia, (c), (d), (e) Comparison of visibility score of WLI and LCI by lesion size. WLI, White light imaging; LCI, Linked color imaging; IM-, lesions without endoscopic intestinal metaplasia; IM+, lesions with mild or sever endoscopic intestinal metaplasia; *, statistically significant.
See this image and copyright information in PMC

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