Abstract
Background and Aims Linked color imaging (LCI) helps screen and diagnose for early gastric cancer by color contrast in different mucosa. RGB (red, green, and blue) pixel brightness quantifies colors, which is relatively objective. Limited studies have combined LCI images with RGB to help screen for early gastric cancer (EGC). We aimed to evaluate the RGB pixel brightness characteristics of EGC and noncancer areas in LCI images. Methods We retrospectively reviewed early gastric cancer (EGC) patients and LCI images. All pictures were evaluated by at least two endoscopic physicians. RGB pixel brightness analysis of LCI images was performed in MATLAB software to compare the cancer with noncancer areas. Receiver operating characteristic (ROC) curve was analyzed for sensitivity, specificity, cut-off, and area under the curve (AUC). Results Overall, 38 early gastric cancer patients were enrolled with 38 LCI images. Pixel brightness of red, green, and blue in cancer was remarkably higher than those in noncancer areas (190.24 ± 37.10 vs. 160.00 ± 40.35, p < 0.001; 117.96 ± 33.91 vs. 105.33 ± 30.01, p = 0.039; 114.36 ± 34.88 vs. 90.93 ± 30.14, p < 0.001, respectively). Helicobacter plyori (Hp) infection was not relevant to RGB distribution of EGC. Whether the score of Kyoto Classification of Gastritis (KCG) is ≥4 or <4, the pixel brightness of red, green, and blue was not disturbed in both cancer and noncancer (p > 0.05). Receiver operating characteristic (ROC) curve for differentiating cancer from noncancer was calculated. The maximum area under the curve (AUC) was 0.767 in B/G, with a sensitivity of 0.605, a specificity of 0.921, and a cut-off of 0.97. Conclusions RGB pixel brightness was useful and more objective in distinguishing early gastric cancer for LCI images.
Highlights
Background and AimsLinked color imaging (LCI) helps screen and diagnose for early gastric cancer by color contrast in different mucosa
We assessed five endoscopic findings included in the Kyoto Classification of Gastritis (KCG) independently [9]: (1) atrophy—none, mild (C1, C2), moderate (C3, O1), and severe (O2, O3); (2) intestinal metaplasia—greyish-white, slightly opalescent, flat, elevated lesion of various sizes; (3) enlarged folds—enlarged and tortuous gastric body folds, not flattening upon insufflation; (4) nodularity—nodular or granular elevated lesions measuring 2-3 mm are uniformly distributed in the antrum and angle; and (5) diffuse redness
Our study demonstrated the feasibility of RGB pixel brightness to distinguish early gastric cancer (EGC) from noncancer areas, especially in R and B
Summary
Linked color imaging (LCI) helps screen and diagnose for early gastric cancer by color contrast in different mucosa. Limited studies have combined LCI images with RGB to help screen for early gastric cancer (EGC). We aimed to evaluate the RGB pixel brightness characteristics of EGC and noncancer areas in LCI images. We retrospectively reviewed early gastric cancer (EGC) patients and LCI images. RGB pixel brightness analysis of LCI images was performed in MATLAB software to compare the cancer with noncancer areas. RGB pixel brightness was useful and more objective in distinguishing early gastric cancer for LCI images. Screening and early diagnosis for EGC is vital, especially to those with high risk factors, such as Helicobacter pylori infection [2] and intestinal metaplasia. Taking into account physicians’ subjective judgment, missed diagnosis is unavoidable [7], especially for inexperienced endoscopic physicians
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