Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: A noninferiority study

BACKGROUND Lugol chromoendoscopy(LCE)has served as a standard screening technique in high-risk patients with esophageal cancer.Nevertheless,LCE is not suitable for general population screening given its side effects.Linked color imaging(LCI)is a novel image-enhanced endoscopic technique that can distinguish subtle differences in mucosal color.AIM To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions.METHODS In this prospective study,we enrolled 543 patients who underwent white light imaging(WLI),LCI and LCE successively.We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions.Clinicopathological features and color analysis of lesions were assessed.RESULTS In total,43 patients(45 neoplastic lesions)were analyzed.Among them,36 patients(38 neoplastic lesions)were diagnosed with LCI,and 39 patients(41 neoplastic lesions)were diagnosed with LCE.The sensitivity of LCI was similar to that of LCE(83.7%vs 90.7%,P=0.520),whereas the specificity of LCI was greater than that of LCE(92.4%vs 87.0%,P=0.007).The LCI procedure time in the esophageal examination was significantly shorter than that of LCE[42(34,50)s vs 160(130,189)s,P<0.001].The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI.However,the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer.CONCLUSION LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions,and LCI represents a promising screening strategy for general populations.

Characteristics of superficial esophageal squamous cell carcinomas undetectable with narrow-band imaging endoscopy

Background The detection rate of narrow-band imaging(NBI)for superficial esophageal squamous cell carcinoma(SESCC),including high-grade intraepithelial neoplasia,is significantly higher than that of white-light endoscopy.However,there are SESCCs that are undetectable by NBI but detectable by Lugol chromoendoscopy(LCE)and the characteristics of these SESCCs are still unknown.Thus,this study aimed to clarify the characteristics of SESCC that are undetectable using NBI.Methods Patients with current SCC or a history of SCC in the head and neck or in the esophagus were enrolled.The inspection of the esophagus was initiated by NBI,followed by LCE.Biopsies were taken of all suspected SESCC lesions during NBI observation and Lugol-voiding lesions(LVLs)that were irregularly shaped and>5mmand/or pink in color during LCE observation.The characteristics of SESCC that were undetectable with NBI were statistically analysed.Results Overall,147 lesions in 105 cases were histologically diagnosed as SESCC.Twenty in 15 cases were NBI-undetectable lesions,all of which were macroscopic flat type(0-IIb).The median sizes of the NBI-undetectable lesions and NBI-detectable lesions were both 15mm(P=0.47).Multivariate analysis revealed independent factors for NBI-undetectable lesions such as numerous irregularly shaped LVLs(odds ratio[OR]:4.94,95%confidence interval[CI]:1.39–17.5,P<0.05)and anterior wall position(OR:4.99,95%CI:1.58–15.8,P<0.05).Conclusions The detection of SESCCs with NBI is challenging when lesions are morphologically completely flat,in cases with numerous irregularly shaped LVLs,and if located at the anterior wall.