Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Imaging

Background:

• Standard colonoscopy lacks reliable discrimination between neoplastic and nonneoplastic colorectal lesions.
• Computed virtual chromoendoscopy, such as the Fujinon intelligent color enhancement (FICE) system, offers a dyeless imaging technique to enhance mucosal and vascular patterns.
• Accurate histological determination of colorectal lesions is crucial for effective patient management.

Purpose of the Study:

• To compare the diagnostic feasibility of FICE, standard colonoscopy, and conventional chromoendoscopy with indigo carmine for determining colorectal lesion histology.
• To evaluate the effectiveness of FICE in low- and high-magnification modes.
• To assess the ability of FICE to differentiate between neoplastic and nonneoplastic colorectal lesions.

Main Methods:

• A prospective trial involving 63 patients with 150 flat or sessile colorectal lesions (<20 mm).
• Each lesion was examined using standard colonoscopy, FICE, and conventional chromoendoscopy with indigo carmine in low- and high-magnification modes.
• Histopathology was confirmed via endoscopic resection or biopsy, and images were analyzed by a blinded reader.

Main Results:

• The FICE system demonstrated high sensitivity and specificity for adenoma identification, with diagnostic accuracy of 83% (low magnification) and 90% (high magnification).
• Compared to standard colonoscopy, FICE showed significantly improved sensitivity and diagnostic accuracy at both low (P < 0.02) and high (P < 0.03) magnifications.
• FICE's performance was comparable to that of conventional chromoendoscopy in distinguishing neoplastic from nonneoplastic lesions.

Conclusions:

• The FICE system effectively identifies morphological details that predict adenomatous histology in colorectal lesions.
• FICE is superior to standard colonoscopy for differentiating neoplastic from nonneoplastic colorectal lesions.
• FICE offers diagnostic performance equivalent to conventional chromoendoscopy, providing a valuable dyeless alternative.