Pode o Blue Laser Imaging colaborar no diagnóstico diferencial entre lesões neoplásicas e não neoplásicas colorretais? / Can Blue Laser Imaging collaborate in the differential diagnosis between neoplastic and non-neoplastic colorectal lesions?

Introdução: Imagem endoscópica aprimorada permite o diagnóstico diferencial das lesões colorretais em tempo real através do estudo da microvasculatura. Objetivo: Revisar o uso do Blue Laser Imaging (BLI) na análise do padrão dos capilares para o diagnóstico diferencial entre lesões neoplásicas e não neoplásicas. Métodos: Esta é revisão integrativa da literatura que colheu informações publicadas em plataformas virtuais em português e inglês. A busca para leitura e análise foi realizada nas plataformas SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus. Os descritores retirados do DeCS/MESH foram: "Blue laser imaging. Endoscopia. Cromoendoscopia, Pólipos colorretais. Magnificação" e seus correspondentes em inglês "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" com busca AND ou OR, considerando o título e/ou resumo. Foram incluídos somente os que tivessem maior correlação ao tema, e neles foi baseada a revisão com leitura, na íntegra, dos textos. Resultados: Ao final resultaram 22 artigos que compuseram esta revisão. Conclusão: BLI associada à magnificação mostrou bons resultados no diagnóstico histológico preditivo em tempo real para as lesões de cólon e reto.

Introduction: Improved endoscopic imaging allows the differential diagnosis of colorectal lesions in real time through the study of the microvasculature. Objective: To review the use of Blue Laser Imaging (BLI) in analyzing the capillary patern for the differential diagnosis between neoplastic and nonneoplastic lesions. Methods: This is an integrative review of the literature that collected information published on virtual platforms in Portuguese and English. The search for reading and analysis was carried out on the SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. The descriptors taken from DeCS/MESH were: "Blue laser imaging. Endoscopy. Chromoendoscopy, Colorectal polyps. Magnification" and its English counterparts "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" with AND or OR search, considering the title and/or abstract. Only those that had the greatest correlation to the topic were included, and the review was based on them, with reading, in full, of the texts. Results: In the end, 22 articles resulted that made up this review. Conclusion: BLI associated with magnification showed good results in real-time predictive histological diagnosis for colon and rectal lesions.

Comparison of the diagnostic effect of early gastric cancer between magnifying blue laser imaging model and magnifying narrow-band imaging model based on deep learning / 中华消化杂志

Objective:To develop early gastric cancer (EGC) detection system of magnifying blue laser imaging (ME-BLI) model and magnifying narrow-band imaging (ME-NBI) model based on deep convolutional neural network, to compare the performance differences of the two models and to explore the effects of training methods on the accuracy.Methods:The images of benign gastric lesions and EGC under ME-BLI and ME-NBI were respectively collected. A total of five data sets and three test sets were collected. Data set 1 included 2 024 noncancerous lesions and 452 EGC images under ME-BLI. Data set 2 included 2 024 noncancerous lesions and 452 EGC images under ME-NBI. Data set 3 was the combination of data set 1 and 2 (a total of 4 048 noncancerous lesions and 904 EGC images under ME-BLI and ME-NBI). Data set 4: on the basis of data set 2, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added (2 086 noncancerous lesions and 2 757 EGC images under ME-NBI). Data set 5: on the basis of data set 3, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added(4 110 noncancerous lesions and 3 209 EGC images under ME-NBI and ME-BLI). Test set A included 422 noncancerous lesions and 197 EGC images under ME-BLI. Test set B included 422 noncancerous lesions and 197 EGC images under ME-NBI. Test set C was the combination of test set A and B (844 noncancerous and 394 EGC images under ME-BLI and ME-NBI). Five models were constructed according to these five data sets respectively and their performance was evaluated in the three test sets. Per-lesion video was collected and used to compare the performance of deep convolutional neural network models under ME-BLI and ME-NBI for the detection of EGC in clinical environment, and compared with four senior endoscopy doctors. The primary endpoint was the diagnostic accuracy of EGG, sensitivity and specificity. Chi-square test was used for statistical analysis.Results:The performance of model 1 was the best in test set A with the accuracy, sensitivity and specificity of 76.90% (476/619), 63.96% (126/197) and 82.94% (350/422), respectively. The performance of model 2 was the best in test set B with the accuracy, sensitivity and specificity of 86.75% (537/619), 92.89% (183/197) and 83.89% (354/422), respectively. The performance of model 3 was the best in test set B with the accuracy, sensitivity and specificity of 86.91% (538/619), 84.26% (166/197) and 88.15% (372/422), respectively. The performance of model 4 was the best in test set B with the accuracy, sensitivity and specificity of 85.46% (529/619), 95.43% (188/197) and 80.81% (341/422), respectively. The performance of model 5 was the best in test set B, with the accuracy, sensitivity and specificity of 83.52% (517/619), 96.95% (191/197) and 77.25% (326/422), respectively. In terms of image recognition of EGC, the accuracy of models 2 to 5 was higher than that of model 1, and the differences were statistically significant ( χ2=147.90, 149.67, 134.20 and 115.30, all P<0.01). The sensitivity and specificity of models 2 and 3 were higher than those of model 1, the specificity of model 2 was lower than that of model 3, and the differences were statistically significant ( χ2=131.65, 64.15, 207.60, 262.03 and 96.73, all P < 0.01). The sensitivity of models 4 and 5 was higher than those of models 1 to 3, and the specificity of models 4 and 5 was lower than those of models 1 to 3, and the differences were statistically significant ( χ2=151.16, 165.49, 71.35, 112.47, 132.62, 153.14, 176.93, 74.62, 14.09, 15.47, 6.02 and 5.80, all P<0.05). The results of video test based on lesion showed that the average accuracy of doctors 1 to 4 was 68.16%. And the accuracy of models 1 to 5 was 69.47% (66/95), 69.47% (66/95), 70.53% (67/95), 76.84% (73/95) and 80.00% (76/95), respectively. There were no significant differences in the accuracy among models 1 to 5 and between models 1 to 5 and doctors 1 to 4 (all P>0.05). Conclusions:ME-BLI EGC recognition model based on deep learning has good accuracy, but the diagnostic effecacy is sligntly worse than that of ME-NBI model. The effects of EGC recognition model of ME-NBI combined with ME-BLI is better than that of a single model. A more sensitive ME-NBI model can be obtained by increasing the number of ME-NBI images, especially the images of EGG, but the specificity is worse.

Blue Laser Imaging, Blue Light Imaging, and Linked Color Imaging for the Detection and Characterization of Colorectal Tumors

A laser endoscopy system was developed in 2012. The system allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) to be performed as modes of narrow-band light observation; these modes have been reported to be useful for tumor detection and characterization. Furthermore, an innovative endoscopy system using four-light emitting diode (LED) multilight technology was released in 2016 to 2017 in some areas in which laser endoscopes have not been approved for use, including the United States and Europe. This system enables blue light imaging (this is also known as BLI) and LCI with an LED light source instead of a laser light source. Several reports have shown that these modes have improved tumor detection. In this paper, we review the efficacy of BLI and LCI with laser and LED endoscopes in tumor detection and characterization.

New Diagnostic Approach for Esophageal Squamous Cell Neoplasms Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining

A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o'clock position inside the iodine-unstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o'clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.

Blue Laser Imaging with a Small-Caliber Endoscope Facilitates Detection of Early Gastric Cancer

Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished from inflamed mucosa. We treated a patient with a small early gastric cancer that was difficult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, blue laser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from the surrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even with small-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosal dissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinoma localized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. This small early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.

Advances in the accurate diagnosis of early carcinoma of digestive tract in blue laser endoscopy / 中国内镜杂志

?At present, the diagnosis and treatment of early cancer in digestive tract is a hot topic, which is defined as cancer confined to the mucosa layer and submucosa, including early esophageal cancer, early gastric cancer and early colorectal cancer. For gastrointestinal cancer early diagnosis technology has been from a single common white light endoscopy, endoscopic gradually transition to the pigment dyeing narrow-band imaging technology, electronic (narrow band imaging, NBI), intelligent electronic spectroscopic techniques (flexible spectral imaging color enhancement, FICE), magnifying endoscopy, endoscopic confocal optical microscopy, confocal laser endomicroscopy, CLE), etc., so as to improve the early cancer detection rate, can even provide lesions in depth and scope, histopathology, and blue laser endoscope is introduced by the Fuji company blue laser endoscopic system (LASEREO), the more possibility for accurate diagnosis of early carcinoma of digestive tract. In this paper, the progress of blue laser imaging technology (blue laser imaging, BLI) in the accurate diagnosis of early carcinoma of digestive tract was overviewed.

Features of clinicopathology and blue laser imaging combined with magnification endoscopy of patients with early gastric cancer / 中华消化内镜杂志

Objective To study the clinical and pathological characteristics of early gastric cancer ( EGC) and to evaluate the value of blue laser imaging combined with magnification endoscopy ( BLI-ME) in the diagnosis of EGC. Methods A retrospective study was conducted on data of 255 patients with EGC diagnosed in Huashan Hospital from January 2014 to January 2017, including 33 cases of preoperative BLI-ME intensive examination. According to the Japanese classification of gastric carcinoma of Japanese Gastric Cancer Association, the EGCs were histopathologically divided into differentiated and undifferentiated subtypes. Clinical characteristics, endoscopic features, pathological type, lymph node metastasis, and lesion characteristics of BLI-ME were analyzed. Results Among the 255 cases of EGC, 164 cases ( 63. 31％) were male, 242 cases ( 94. 90％) were over 40 years old, 182 cases ( 71. 37％) belonged to differentiated type, 93 cases ( 36. 47％) were located in gastric antrum, 92 cases ( 36. 08％) were type 0-Ⅱc under endoscopy, and 37 cases (14. 51％) had lymph node metastasis. Comparative analysis showed that the lymph node metastasis rate was significantly lower in mucosal carcinoma compared to submucosal carcinoma[ 5. 04％(7/139) VS 25. 86％ (30/116),χ2=22. 109, P=0. 000], lower in differentiated carcinoma compared to undifferentiated carcinoma[9. 89％ (18/182) VS 26. 03％ (19/73), χ2=10. 938, P=0. 002], and lower in tumors with maximum diameter of lesion≤2. 0 cm compared to maximum diameter of lesion>2. 0 cm [ 9. 88％ ( 16/162 ) VS 22. 58％ ( 21/93 ) , χ2 =7. 687, P=0. 009 ] . Among the 33 cases undergoing BLI-ME, differentiated EGC was mainly fine-network pattern (13. 64％, 3/22), intralobular loop pattern (ILL)-1 (59. 09％, 13/22) and ILL-2 (22. 73％, 5/22), whereas undifferentiated subtype patients were characterized as ILL-2 ( 45. 45％, 5/11 ) and corkscrew pattern ( 54. 55％, 6/11 ) . Conclusion The incidence of EGC is higher in male with age over 40 years. Gastric lesions occur most frequently in the antrum, and the most common microscopic morphology is 0-Ⅱc type. Tumor>2. 0 cm or invasion of submucous layer, and undifferentiated carcinoma are prone to lymph node metastasis. The assessment of mucosal microvascular pattern and micro surface structure under BLI-ME facilitate to determine the pathological type of EGC.

Diagnostic value of VS classification of magnifying endoscopy with blue laser imaging for gastric precancerous lesion and early gastric cancer / 中华消化内镜杂志

Objective To evaluate the diagnostic value of VS classification of magnifying endoscopy with blue laser imaging ( ME-BLI) for gastric precancerous lesion and early gastric cancer. Methods A retrospective study was performed on the data of 313 patients ( 322 lesions) with gastric mucosal lesions undergoing ME-BLI in digestive endoscopy center of Renmin Hospital of Wuhan University from January 2014 to January 2017. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of VS classification by ME-BLI in diagnosis of gastric precancerous lesion and early cancer were analyzed. Results Among the 322 lesions, 57 were pathologically diagnosed as cancerous lesions and 265 were non-cancerous lesions. According to VS classification of ME-BLI, 98. 2%(56/57) VS structures of the cancerous lesions were irregular or disappearing, and 100. 0%( 57/57 ) cancerous lesions had clear demarcation. Taking the pathological diagnosis as the gold standard, the accuracy of VS classification of ME-BLI was 93. 8%(302/322), with a good consistency with pathological diagnosis(Kappa＝0. 810). The sensitivity, specificity, positive predictive value, and negative predictive value were 98. 2%( 56/57), 92. 8%( 246/265 ), 74. 7%( 56/75 ) and 99. 6%( 246/247 ), respectively. Conclusion The VS classification of ME-BLI is an effective method with high accuracy, sensitivity and specificity for diagnosis of gastric precancerous lesion and early gastric cancer.

Diagnostic value of magnifying endoscopy with blue laser imaging for early esophageal cancers / 中华消化内镜杂志

Objective To evaluate the magnifying endoscopy with blue laser imaging( M-BLI) for early esophageal cancers. Methods A total of 153 focal esophageal lesions detected with conventional white light endoscopy (WLE) based on changes of mucosal shape and color were enrolled in this study. Patients were examined with WLE, M-BLI, and 1. 25% Lugol′s iodine chromoendoscopy between April 2015 and December 2016. Diagnostic consistency of M-BLI and Lugol′s iodine chromoendoscopy were evaluated with pathology as a golden standard. Results Pathological diagnosis showed there were 19 lesions of esophagitis or chronic mucosal inflammation,92 of low grade intraepithelial neoplasia,and 42 high grade intraepithelial neoplasia or early cancer. Diagnostic sensitivities of WLE, M-BLI and Lugol′s iodine chromoendoscopy of screening early cancer were 66. 7%( 28/42 ), 95. 2%( 40/42 ), and 95. 2%( 40/42 ) respectively, the specificities were 57. 7%( 64/111 ), 91. 9%( 102/111 ), and 92. 8%( 103/111 ) respectively. The consistency rate between endoscopy and pathological examination were 60. 1%( 92/153 ), 92. 8%(142/153), and 93. 5%(143/153) respectively,and the Kappa values were 0. 565, 0. 891, and 0. 906 respectively. The detection rate of M-BLI was higher than that of WLE alone ( χ2 ＝9. 166, P＝0. 002). Conclusion The diagnostic value of M-BLI for early esophageal cancer is similar to that of Lugol′s iodine chromoendoscopy. However, M-BLI is easier to operate, and superior to Lugol′s iodine staining endoscopy in the absence of iodine allergy, long operating time and patients′intolerance.

Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening

White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright images in the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellent visibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green color of metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history of Helicobacter pylori eradication. LCI facilitates color-based recognition of early gastric cancers of all morphological types, including flat lesions or those in an H. pylori-negative normal background mucosa as well as the diagnosis of inflamed mucosae including erosions. LCI reveals changes in mucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection of early esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinal cancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtain images useful for establishing a diagnosis. It is important to observe esophageal cancers (brown) using BLI and gastric cancers (orange) surrounded by intestinal metaplasia (purple) and duodenal cancers (orange) by LCI.

Diagnostic value of blue laser imaging combined with magnifying endoscopy for precancerous lesions and early gastric cancers / 中华消化内镜杂志

Objective To evaluate the diagnostic value of blue laser imaging( BLI) combined with magnifying endoscopy for precancerous lesions and early gastric cancers. Methods From September 2015 to May 2016, a total of 249 gastric lesions detected with conventional white light endoscopy ( WLE) on the basis of the assessment of mucosal shape and color were enrolled in this study. The pathological results were used as golden standard,and diagnostic accuracy rates of precancerous lesions or early cancers by white light magnification alone,BLI?contrast magnification and BLI?bright magnifier were determined according to the VS criteria. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement ( Kappa ) test, and diagnostic value was compared with McNemar paired Chi?square test. Results Pathological examination showed chronic gastritis in 149 lesions, intestinal metaplasia in 67, low grade intra?epithelial neoplasia in 8, and high grade intra?epithelial neoplasia or early cancer in 25. The concordance rates of lesions were 76?7% for white light magnification alone, 85?1% for BLI?contrast magnification, and 86?7% for BLI?bright magnification. Kappa values were 0?571, 0?730, and 0?760 respectively. For the screening of high grade intra?epithelial neoplasia or early cancer, the diagnostic sensitivities were 72?0%, 92?0%, and 92?0%, respectively, the specificities were 95?5%, 98?2%, and 99?1%,the consistencies were 93?2%,97?6%,98?4%,and the Kappa values were 0?642,0?871,and 0?911. In contrast to white light magnification alone,the concordance between endoscopic diagnosis and pathological diagnosis of BLI?contrast magnification and BLI?bright magnification was significantly higher(P<0?05).And in the diagnosis of high?grade intraepithelial neoplasia or early gastric cancer,the concordance between endoscopic diagnosis and pathological diagnosis of BLI?contrast magnification and BLI?bright magnification was higher than that of white light magnification alone( P<0?05) . Conclusion BLI combined with magnifying endoscopy may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.

Advances in Application of Blue Laser Imaging in Diagnosis of Early Upper Gastrointestinal Cancer / 胃肠病学

Blue laser imaging (BLI) is a new endoscopic system equipped with the laser beam emitting two different wavelengths.It produces bright and high resolution images for observation of microvascular and microsurface patterns of esophageal and gastric mucosa, helping the diagnosis of early upper gastrointestinal cancer.Compared with the existed endoscopic techniques, BLI shows its unique advantages.In this article, advances in application of BLI in diagnosis of early upper gastrointestinal cancer were reviewed.

Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett's Esophagus

Barrett's adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett's adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett's esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett's adenocarcinoma.