The Fujinon Intelligent Color Enhancement System (FICE)

Abstract

Purpose: Conventional colonoscopy offers no reliable discrimination between neoplastic and nonneoplastic colorectal lesions and histopathology assessment remains the gold standard method of colorectal lesions classification. Computed virtual chromoendoscopy (CVC) with the Fujinon intelligent color enhancement (FICE) system is a new dyeless imaging technique that is based on narrowing the bandwidth of the conventional endoscopic image arithmetically by a spectral estimation technology without the need of optical filters as in narrow band imaging. It enhances mucosal and vascular patterns and thus it may allow the classification of colorectal lesions in real time and distinguishing neoplastic from nonneoplastic lesions. The aim of the study is to assess the efficacy of the new FICE system for diagnosing colorectal neoplasia during routine colonoscopy. Methods: Thirty eight patients underwent colonoscopy using high resolution zoom colonoscopes with the EPC 4400 processor (Fujinon Inc. Ft Wayne, NJ). Each colorectal lesion was evaluated in FICE mode previously determined to offer the highest contrast between neoplastic and non-neoplastic tissue (Image mode “4”). The surface pit pattern was determined using the Kudo pit classification with patterns 1 and 2 representing non-neoplastic lesions and patterns 3 to 5 representing neoplastic lesions. Histopathology of all lesions was confirmed by evaluation of endoscopic mucosal resection or biopsy specimens. The sensitivities, specificities and accuracies and their corresponding confidence intervals of the FICE system in predicting neoplasia were reported as compared to gold standard histopathology. Results: A total of 38 patients underwent colonoscopy (female 19, male 19). Of the total of 57 colorectal lesions (a mean size of 13 mm) found in thirty six patients, 37 were neoplastic lesions (tubular adenoma 25, tubulovillous 8, villous 2, adenocarcinoma 2) and 20 were hyperplastic polyps. For identifying neoplastic lesions, the FICE system had a sensitivity of 86.5% (CI 75.5–97.5%), specificity of 60.0% (CI 38.5–81.5%) and diagnostic accuracy of 77.2% (CI 66.3–88.0%) respectively. Conclusion: The FICE system as in vivo modality has an overall good accuracy for prediction of colorectal neoplasia. However further studies assessing the efficacy of this technique in large prospective cohorts are warranted.