Introduction
The prevalence of Helicobacter pylori (H.pylori) positive patients has gradually decreased in Japan due to eradication therapy, and H.pylori-uninfected gastric cancer (HPUGC) is expected to increase relatively. Recently, HPUGC, such as gastric adenocarcinoma of fundic-gland type (GAFG), gastric adenocarcinoma of foveolar-type (GAFV), adenocarcinoma of differentiated type (DGA) and signet ring cell carcinoma (SRCC) has been increasingly reported. Since the detection and endoscopic diagnosis of HPUGC is considered to be difficult [1]. The effective observation methods in screening endoscopy to detect HPUGC. In this context, a new image enhancement technology called Texture and Color Enhancement Imaging (TXI; Olympus Medical Systems Corporation) which optimizes the three elements: structure (texture) enhancement, color tone, and brightness correction was developed in 2020. There have been several reports on the usefulness of TXI for the detection and endoscopic diagnosis of mucosal atrophy or gastric neoplasm [2-6]. However, the usefulness of TXI for the detection of HPUGC has been investigated.
Aims & Methods
The aim of the study is to investigate whether the visibility of HPUGC improved using TXI and NBI compared with WLI as a single-center retrospective clinical study. We enrolled 40 HPUGC lesions endoscopically imaged with WLI, TXI-1, TXI-2, and NBI in our facility between October 2020 and March 2023. In addition, the visibility of HPUGCs was analyzed for each factor, such as histological type, coloration, and macroscopic type. Ten endoscopists (5 experts and 5 non-experts) evaluated the images, and visibility changes were scored by endoscopists as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The total visibility score of ≥40 in all endoscopists and /≥20 in each of the 5 endoscopists was defined as improved visibility, 21-39/11-19 as unchanged visibility, and 20≤/10≤ as decreased visibility. The intraclass correlation coefficients (ICC) were calculated and evaluated for inter-rater agreement.
Results
The histological types were classified as GAFG (n=24), GAFV (n=9), DGA (n=4), and SRCC (n=3). There were 17 reddish lesions and 23 whitish lesions. In the macroscopic type, there were type 0-Ⅰ (n=11), type 0-Ⅱa (n=13), type 0-Ⅱb (n=11), and type 0-Ⅱc (n=5) lesions. The visibility improvement rate for all endoscopists in all HPUGCs was TXI-1: 55%, TXI-2: 29.7%, and NBI: 7.5%. The overall ICCs were TXI-1: 0.86, TXI-2: 0.84, and NBI: 0.90, which were almost perfect. GAFG (all/experts/trainees: 79/54/79%) and SRCC (all/experts/trainees: 67/67/67%) showed improved visibility with TXI-1. In contrast, GAFV and DGA did not improve the visibility. The whitish lesions (all/experts/trainees: 74/52/74%) showed improved the visibility with TXI-1, but the reddish lesions did not improve visibility. Among the macroscopic type , type 0-Ⅱa (overall/experts/trainees: 85/54/85%) and type 0-Ⅱb (overall/experts/trainees: 73/64/73%) showed improved visibility with TXI-1. The all ICCs of each factor were above 0.7, which indicated generally good correlations.
Conclusion
The usefulness of TXI-1 compared with WLI led to the improved visibility of the whitish lesions such as GAFG and SRCC for both experts and trainees when evaluated subjectively and objectively.
References
1. Ishibashi, F., et al., Exploring quality indicators for the detection of Helicobacter pylori-naïve gastric cancer: a cross-sectional nationwide survey. Clinical Endoscopy, 2023. Apr 4. doi: 10.5946/ce.2022.167.
2. Abe, S., et al., Emerging texture and color enhancement imaging in early gastric cancer. Dig Endosc, 2022. 34(4): p. 714-720.
3. Sugimoto, M., et al., Efficacy of high-vision transnasal endoscopy using texture and colour enhancement imaging and narrow-band imaging to evaluate gastritis: a randomized controlled trial. Ann Med, 2022. 54(1): p. 1004-1013.
4. Abe, S., et al., Visibility of early gastric cancer in texture and color enhancement imaging. DEN Open, 2022. 2(1): p. e46.
5. Ishikawa, T., et al., Efficacy of Texture and Color Enhancement Imaging in visualizing gastric mucosal atrophy and gastric neoplasms. Sci Rep, 2021. 11(1): p. 6910.
6. Kawasaki, A., et al., Usefulness of third-generation narrow band imaging and texture and color enhancement imaging in improving visibility of superficial early gastric cancer: A study using color difference. DEN Open, 2022. 3(1): p. e186.