AIM:To evaluate the efficacy of computer-assisted color analysis of colorectal lesions using a novel auto-fluorescence imaging(AFI)system to distinguish neoplastic lesions from non-neoplastic lesions and to predict th...AIM:To evaluate the efficacy of computer-assisted color analysis of colorectal lesions using a novel auto-fluorescence imaging(AFI)system to distinguish neoplastic lesions from non-neoplastic lesions and to predict the depth of invasion.METHODS:From January 2013 to April 2013,consecutive patients with known polyps greater than 5 mm in size who were scheduled to undergo endoscopic treatment at The Jikei University Hospital were prospectively recruited for this study.All lesions were evaluated using a novel AFI system,and color-tone sampling was performed in a region of interest determined from narrow band imaging or from chromoendoscopy findings without magnification.The green/red(G/R)ratio for each lesion on the AFI images was calculated automatically using a computer-assisted color analysis system that permits real-time color analysis during endoscopic procedures.RESULTS:A total of 88 patients with 163 lesions were enrolled in this study.There were significant differences in the G/R ratios of hyperplastic polyps(non-neoplastic lesions),adenoma/intramucosal cancer/submucosal(SM)superficial cancer,and SM deep cancer(P<0.0001).The mean±SD G/R ratios were 0.984±0.118in hyperplastic polyps and 0.827±0.081 in neoplastic lesions.The G/R ratios of hyperplastic polyps were significantly higher than those of neoplastic lesions(P<0.001).When a G/R ratio cut-off value of>0.89 was applied to determine non-neoplastic lesions,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy were 83.9%,82.6%,53.1%,95.6%and 82.8%,respectively.For neoplastic lesions,the mean G/R ratio was 0.834±0.080 in adenoma/intramucosal cancer/SM superficial cancer and 0.746±0.045 in SM deep cancer.The G/R ratio of adenoma/intramucosal cancer/SM superficial cancer was significantly higher than that of SM deep cancer(P<0.01).When a G/R ratio cut-off value of<0.77 was applied to distinguish SM deep cancers,the sensitivity,specificity,PPV,NPV,and accuracy were80.0%,84.4%,29.6%,98.1%and 84.1%,respectively展开更多
Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button....Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button.In IEE,there are many advantages in diagnosis of neoplastic tumors,evaluation of invasion depth for cancerous lesions,and detection of neoplastic lesions.In narrow band imaging(NBI) systems(Olympus Medical Co.,Tokyo,Japan),optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used.Mucosal surface blood vessels are seen most clearly at 415 nm,which is the wavelength that corresponds to the hemoglobin absorption band,while vessels in the deep layer of the mucosa can be detected at 540 nm.Thus,NBI also can detect pit-like structures named surface pattern.The flexible spectral imaging color enhancement(FICE) system(Fujifilm Medical Co.,Tokyo,Japan) is also an IEE but different to NBI.FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images.FICE can enhance vascular and surface patterns.The autofluorescence imaging(AFI) video endoscope system(Olympus Medical Co.,Tokyo,Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions.AFI light comprises a blue light for emitting and a green light for hemoglobin absorption.The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.展开更多
Barrett’s esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neopla...Barrett’s esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides "optical biopsies" and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett’s surveillance.展开更多
文摘AIM:To evaluate the efficacy of computer-assisted color analysis of colorectal lesions using a novel auto-fluorescence imaging(AFI)system to distinguish neoplastic lesions from non-neoplastic lesions and to predict the depth of invasion.METHODS:From January 2013 to April 2013,consecutive patients with known polyps greater than 5 mm in size who were scheduled to undergo endoscopic treatment at The Jikei University Hospital were prospectively recruited for this study.All lesions were evaluated using a novel AFI system,and color-tone sampling was performed in a region of interest determined from narrow band imaging or from chromoendoscopy findings without magnification.The green/red(G/R)ratio for each lesion on the AFI images was calculated automatically using a computer-assisted color analysis system that permits real-time color analysis during endoscopic procedures.RESULTS:A total of 88 patients with 163 lesions were enrolled in this study.There were significant differences in the G/R ratios of hyperplastic polyps(non-neoplastic lesions),adenoma/intramucosal cancer/submucosal(SM)superficial cancer,and SM deep cancer(P<0.0001).The mean±SD G/R ratios were 0.984±0.118in hyperplastic polyps and 0.827±0.081 in neoplastic lesions.The G/R ratios of hyperplastic polyps were significantly higher than those of neoplastic lesions(P<0.001).When a G/R ratio cut-off value of>0.89 was applied to determine non-neoplastic lesions,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy were 83.9%,82.6%,53.1%,95.6%and 82.8%,respectively.For neoplastic lesions,the mean G/R ratio was 0.834±0.080 in adenoma/intramucosal cancer/SM superficial cancer and 0.746±0.045 in SM deep cancer.The G/R ratio of adenoma/intramucosal cancer/SM superficial cancer was significantly higher than that of SM deep cancer(P<0.01).When a G/R ratio cut-off value of<0.77 was applied to distinguish SM deep cancers,the sensitivity,specificity,PPV,NPV,and accuracy were80.0%,84.4%,29.6%,98.1%and 84.1%,respectively
文摘Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button.In IEE,there are many advantages in diagnosis of neoplastic tumors,evaluation of invasion depth for cancerous lesions,and detection of neoplastic lesions.In narrow band imaging(NBI) systems(Olympus Medical Co.,Tokyo,Japan),optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used.Mucosal surface blood vessels are seen most clearly at 415 nm,which is the wavelength that corresponds to the hemoglobin absorption band,while vessels in the deep layer of the mucosa can be detected at 540 nm.Thus,NBI also can detect pit-like structures named surface pattern.The flexible spectral imaging color enhancement(FICE) system(Fujifilm Medical Co.,Tokyo,Japan) is also an IEE but different to NBI.FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images.FICE can enhance vascular and surface patterns.The autofluorescence imaging(AFI) video endoscope system(Olympus Medical Co.,Tokyo,Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions.AFI light comprises a blue light for emitting and a green light for hemoglobin absorption.The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.
文摘Barrett’s esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides "optical biopsies" and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett’s surveillance.
