Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: A noninferiority study

Table 1 Clinicopathological features of the patients

Item	n	% (n/n total)
Patients with suspected lesions1	115	21.2 (115/543)
Inflammation	72	13.2
LGIN	25	4.6
HGIN	3	0.5
ESCC	15	2.7
Suspected lesions, including non-neoplastic	141	-
Neoplastic lesions2	45	31.9 (45/141)
LGIN	25	17.7 (25/141)
HGIN	3	2.1 (3/141)
ESCC	17	12.1 (17/141)
Neoplastic lesions detected with LCI
LGIN	18	72.0 (18/25)
HGIN	3	100 (3/3)
ESCC	17	100 (17/17)
Neoplastic lesions detected with LCE
LGIN	21	84.0 (21/25)
HGIN	3	100 (3/3)
ESCC	17	100 (17/17)
Neoplastic lesions detected by different diagnosis modality
Only LCI	4	8.9 (4/45)
Only LCE	7	15.6 (7/45)
Both LCI and LCE	34	75.6 (34/45)
Neoplastic lesions per patient, mean (SD)	0.08 (0.29)

¹Suspected lesions included neoplastic lesions and false positives (lesions detected but not confirmed to be neoplastic after histological examination).

²Neoplastic lesions confirmed by histological examination.

ESCC: Esophageal squamous cell carcinoma; HGIN: High-grade intraepithelial neoplasia; LCE: Lugol chromoendoscopy; LCI: Linked color imaging; LGIN; Low-grade intraepithelial neoplasia; SD: Standard deviation.

Table 2 Esophageal neoplastic lesions (non-inflammation) detected using linked color imaging and Lugol chromoendoscopy

Parameter	LCI	LCE	P value
Sensitivity	83.7 (36/43)	90.7 (39/43)	0.520
Specificity	92.4 (462/500)	87.0 (435/500)	0.0071
PPV	48.6 (36/74)	37.5 (39/104)	0.166
NPV	98.5 (462/469)	99.1 (435/439)	0.549

¹P < 0.01.

Data are presented as % (n/n total). LCE: Lugol chromoendoscopy; LCI: Linked color imaging; NPV: Negative predictive value; PPV: Positive predictive value.

Table 3 Clinicopathological features of neoplastic lesions (non-inflammation) detected by linked color imaging and Lugol chromoendoscopy, n (%)

Item		Detected by LCI, n = 36 patients/38 lesions	Detected by LCE, n = 39 patients/41 lesions	P value
Lesion location				0.969
Upper		3 (7.9)	3 (7.3)
Middle		11 (28.9)	11 (26.8)
Lower		24 (63.2)	27 (65.9)
Morphologic type				0.902
I		1 (2.6)	1 (2.4)
IIa		9 (23.7)	8 (19.5)
IIb		18 (47.4)	24 (58.5)
IIc		9 (23.7)	7 (17.1)
III		1 (2.6)	1 (2.4)
Size in mm				0.814
≤ 10		14 (36.8)	18 (43.9)
10-20		3 (7.9)	3 (7.3)
> 20		21 (55.3)	20 (48.8)
Pathology				0.998
LGIN		18 (47.4)	21 (51.2)
HGIN		3 (7.9)	3 (7.3)
ESCC	EP/LPM	3 (7.9)	3 (7.3)
	MM/SM1	1 (2.6)	1 (2.4)
	≥ SM2	13 (34.2)	13 (31.7)
Procedure time (s), median (IQR)		42 (34, 50)	160 (130, 189)	< 0.0011

¹P value < 0.01.

EP: Epithelial; ESCC: Esophageal squamous cell carcinoma; HGIN: High-grade intraepithelial neoplasia; IQR: Interquartile range; LCE: Lugol chromoendoscopy; LCI: Linked color imaging; LGIN: Low-grade intraepithelial neoplasia; LPM: Lamina propria mucosa; MM: Muscularis mucosa; SM1: Submucosa invading ≤ 200 μm below the inferior margin of the muscularis mucosa; SM2: Submucosa invading > 200 μm below the inferior margin of the muscularis mucosa.