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

Q: Why is Lugol chromoendoscopy (LCE) limited for general population screening?

LCE is not suitable for general screening because it can induce esophageal spasms and chest pain and carries risks such as aspiration and iodine allergy.

Q: What was the main objective of the study comparing LCI and LCE?

The study compared the diagnostic performance of linked color imaging (LCI) versus LCE for detecting esophageal squamous cell cancer and precancerous lesions, and assessed whether LCE could be replaced by LCI.

Q: What diagnostic performance results did the study find for LCI versus LCE?

LCI showed similar sensitivity to LCE (83.7% vs 90.7%) but higher specificity (92.4% vs 87.0%), with LCI also having a significantly shorter procedure time.

Sep 24, 2026

Upload by Eliana

Lugol chromoendoscopy (LCE) is used for screening high-risk patients for esophageal cancer, but its adverse effects limit use in the general population. This prospective study enrolled 543 patients undergoing white light imaging, linked color imaging (LCI), and LCE sequentially to compare diagnostic performance for esophageal squamous cell cancer and precancerous lesions, including sensitivity, specificity, and lesion color characteristics. Results showed comparable sensitivity and higher specificity with LCI, plus shorter procedure time. LCI therefore supports a more suitable screening strategy for broader use.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Aim

Methods

Results

Conclusion

Core Tip

| W | J | G | World Journal of
Gastroenterology | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastroenterol 2023 March 28; 29(12): 1899-1910 DOI: 10.3748/wjg.v29.i12.1899 ISSN 1007-9327 (print) ISSN 2219-2840 (online) ORIGINAL ARTICLE Clinical Trials Study Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: Anoninferiority study Zi-Xin Wang, Long-Song Li, Song Su, Jin-Ping Li, Bo Zhang, Nan-Jun Wang, Sheng-Zhen Liu, Sha-Sha Wang, Shuai Zhang, Ya-Wei Bi, Fei Gao, Qun Shao, Ning Xu, Bo-Zong Shao, Yi Yao, Fang Liu, En-Qiang Linghu, Ning-Li Chai Specialty type: Gastroenterology and hepatology Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s scientific quality classification Grade A (Excellent): 0 Grade B (Very good): B, B, B Grade C (Good): 0 Grade D (Fair): 0 Grade E (Poor): 0 P-Reviewer: Abe Y, Japan; Tyakht AV, United Kingdom; Woromogo SH, Congo Received: November 30, 2022 Peer-review started: November 30, 2022 First decision: December 20, 2022 Revised: December 29, 2022 Accepted: March 9, 2023 Article in press: March 9, 2023 Published online: March 28, 2023 Zi-Xin Wang, Long-Song Li, Song Su, Jin-Ping Li, Bo Zhang, Nan-Jun Wang, Sheng-Zhen Liu, ShaSha Wang, Shuai Zhang, Ya-Wei Bi, Fei Gao, Qun Shao, Ning Xu, Bo-Zong Shao, Yi Yao, Fang Liu, En-Qiang Linghu, Ning-Li Chai, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China Corresponding author: Ning-Li Chai, MD, Chief Physician, Professor, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, [China.](China. csxlily@163.com)[ csxlily@163.com](China. csxlily@163.com) Abstract BACKGROUND Lugol chromoendoscopy (LCE) has served as a standard screening technique in high-risk patients with esophageal cancer. Nevertheless, LCE is not suitable for general population screening given its side effects. Linked color imaging (LCI) is a novel image-enhanced endoscopic technique that can distinguish subtle differences in mucosal color. AIM To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions. METHODS In this prospective study, we enrolled 543 patients who underwent white light imaging (WLI), LCI and LCE successively. We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions. Clinicopathological features and color analysis of lesions were assessed. RESULTS In total, 43 patients (45 neoplastic lesions) were analyzed. Among them, 36 patients (38 neoplastic lesions) were diagnosed with LCI, and 39 patients (41 neoplastic lesions) were diagnosed with LCE. The sensitivity of LCI was similar to that of LCE (83.7% vs 90.7%, P = 0.520), whereas the specificity of LCI was greater WJG [https://www.wjgnet.com](https://www.wjgnet.com) 1899 March 28, 2023 Volume 29 Issue 12 Wang ZX et al. LCI and LCE screening esophageal cancer than that of LCE (92.4% vs 87.0%, P = 0.007) . The LCI procedure time in the esophageal examination was significantly shorter than that of LCE [42 (34, 50) s vs 160 (130, 189) s, P < 0.001] . The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI. However, the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer. CONCLUSION LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions, and LCI represents a promising screening strategy for general population

FAQs

Why is Lugol chromoendoscopy (LCE) limited for general population screening?

LCE is not suitable for general screening because it can induce esophageal spasms and chest pain and carries risks such as aspiration and iodine allergy.

What was the main objective of the study comparing LCI and LCE?

The study compared the diagnostic performance of linked color imaging (LCI) versus LCE for detecting esophageal squamous cell cancer and precancerous lesions, and assessed whether LCE could be replaced by LCI.

What diagnostic performance results did the study find for LCI versus LCE?

LCI showed similar sensitivity to LCE (83.7% vs 90.7%) but higher specificity (92.4% vs 87.0%), with LCI also having a significantly shorter procedure time.

Sep 24, 2026

Upload by Eliana