Linked-color imaging combined with the NICE classification system for optical diagnosis of colon polyps: new image-enhanced endoscopic technology for pathological prediction

Abstract

IntroductionLinked-color imaging (LCI) is a recently developed system used in endoscopy. It creates clear and bright endoscopic images using short-wavelength, narrow-band laser light combined with white laser light. The illuminating light and signal processing emphasize slight color differences in abnormal regions that approximate the normal color of the mucosa. As a result, regions initially appearing red become a deeper shade of red, while regions originally appearing white become brighter, yet with natural tones. This process facilitates recognition of slight differences in the color of the mucosa and clarifies the boundaries of the mucosal pit.AimTo determine whether LCI of the colon can improve the correlation between endoscopic findings and pathological diagnosis.MethodsConsecutive patients who underwent colonoscopy requiring polypectomy or removal by biopsy forceps if possible were recruited. Probable polyp histology was assessed by two endoscopists using the Narrow-band imaging International Colorectal Endoscopic (NICE) classification and LCI data. All detected polyps were sent to the pathology department for pathological diagnosis by two pathologists.ResultsIn total, 94 polyps were found in 43 patients. The sensitivity, specificity, positive predictive value, and negative predictive value for neoplastic lesion prediction (NICE type2/3) were 96.5%, 83.8%, 90.2%, and 93.9%, respectively.ConclusionLCI combined with the NICE classification system is a powerful tool for predicting probable histology of colon polyps.

Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

“…The macroscopic aspect of polyps can sometimes predict malignancy or even depth of invasion. Several classifications can be useful: Paris classification based on conventional endoscopy [ 9 , 10 , 11 ], Kudo (Table 1 ), Nice and Sano classification based on chromoendoscopy or virtual chromoendoscopy [narrow-band imaging (NBI), I-Scan, flexible spectral imaging color enhancement (FICE)] [ 12 , 13 , 14 , 15 ]. Macroscopic signs associated with high risk of malignancy are [ 10 ]: non-lifting sign in lesions with no previous attempted resection, Paris 0-IIc lesions, non-granular lateral spreading lesions, pit-pattern Kudo V, NBI pattern NICE III (NBI International Colorectal Endoscopic Classification), Sano capillary pattern type 3.…”

Development and validation of the linked color imaging classification for endoscopic prediction of colorectal polyp histology

“…However, one study reported significantly higher sensitivity, specificity, PPV, and NPV than our study by combining LCI with the NICE classification. 17 The small sample size of the previous study may be one main reason contributing to these results.…”

Use of image-enhanced endoscopy in the characterization of colorectal polyps: Still some ways to go

“…We included in our study standard IEE modalities that are widely available, but the advances in the field of IEE have been relatively fast where even newer technologies, such as blue laser imaging (BLI) (Fujifilm Co, Tokyo, Japan) and linked color imaging (LCI)[161718](Lasereo system, Fujifilm, Tokyo, Japan), iScan optical enhancement,[19] and second-generation (2G) NBI[4] are being rolled out. We still do not have a clear sense of the performance of the older technologies and their impact in real clinical practice let alone these newer IEE modalities.…”