Virtual Chromoendoscopy (FICE) and Magnifying Colonoscopy: A Validation Study

Abstract

Background: Computed virtual chromoendoscopy may improve the diagnosis of colorectal neoplasia. Objective: Prospective validation of high definition endoscopes with Fujinon Intelligent Chromoendoscopy (FICE) in colonoscopy. Methods: Study I compared 10 FICE filters with indigo carmine (IC) or white light endoscopy (WLE) in 10 patients undergoing colonoscopy. Image quality of mucosal and vascular patterns was assessed by two endoscopists independently. Study II compared the best FICE filters to IC and conventional WLE, for the diagnosis of 24 small polyps (≤5 mm) in 18 patients. Endoscopic images of 19 of those polyps were shown sequentially including images of each technique applied (114 images), and single images of each technique for 5 polyps (30 images) were shown in a random order. Predicted histology, degree of certainty in the prediction; image quality among techniques (equal, better, worse) were assessed by 5 endoscopists independently. Results: Study I: FICE-4 obtained the highest ratings (table). For the vascular pattern, FICE- 4 was better than WLE and the other filters. For the mucosal pattern, FICE- 4 was superior to WLE but not significantly, and was worse than IC. FICE-6 allowed for exploring the IC stained mucosa. Study II: For histology prediction, FICE with magnification was as accurate as IC with or without magnification. FICE was superior to WLE in the presence of bowel content and provided better polyp contrast than WLE, but worse than IC. Conclusions: 1) FICE- 4 allows for improved observation of the colonic vascular patterns compared to WLE; 2) for polyp definition FICE improves the performance of WLE; and 3) the accuracy of FICE with -but not without- magnification for the diagnosis of small polyps is similar to IC. Tabled 1SCORES FOR VASCULAR AND MUCOSAL PATTERNS ENDOSCOPIST 1 ENDOSCOPIST 2 Type of endoscopy Mucosal pattern Vascular pattern Sum n Mucosal pattern Vascular pattern Sum n WITHOUT FICE CONVENTIONAL INDIGO 12 59 35 - 44 38 59 20 21 59 40 - 61 38 59 20 FICE 0 1 2 3 4 5 6 7 8 9 6 8 13 14 15 11 11 10 11 14 20 32 42 43 45 32 38 28 30 44 26 38 40 38 55 38 57 38 60 38 43 38 49 37 38 38 41 38 58 38 8 15 20 17 25 19 19 14 15 18 23 33 50 48 49 38 52 34 30 48 31 38 48 38 70 38 65 38 74 38 57 38 71 37 48 38 45 38 66 38 Open table in a new tab