A feasibility study of the use of computed virtual chromoendoscopy for laparoscopic evaluation of peritoneal metastases.
Detection of an incipient peritoneal carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. Fujinon Intelligent Chromo Endoscopy (FICE) is a spectral image processing technology that enhances the contrast of the target tissue. The aim of this study is to investigate the usefulness of FICE system during peritoneal endoscopy and to establish the optimal FICE preset(s) for peritoneal exploration and PC detection.



A total of 561 images corresponding to 51 different areas of PC nodules and normal peritoneum were recorded during peritoneal endoscopies (For each area, one white light endoscopy (WLE) image and 10 FICE images). Three groups of 5 evaluators each: senior surgeons, surgical residents and medical students assessed these images. In a first questionnaire, the evaluators gave a score ranging from 1 to 10 to each image, and the three best FICE channels were determined. In a second questionnaire, five criteria were studied specifically: contrast, brightness, vascular architecture, differentiation between organs and detection of PC. The evaluators ranked the WLE and the three best FICE channel images according to these criteria.



The three best FICE channels were channels 6, 2 and 9 with mean scores of 6.21 ± 1.59, 6.17 ± 1.48 and 6.06 ± 1.52, respectively. FICE Channel 2 was superior to WLE and other FICE channels, in terms of contrast (p < 10-4), visualization of vascular architecture (p < 10-4), differentiation between organs (p < 10-4) and detection of PC (p < 10-4); and ranked first in 38.8, 41.5, 31 and 46.9 % of the cases, respectively.



FICE system provides adequate illumination of the abdominal cavity and a unique contrast that enhances the vascular architecture. FICE Channel 2 is the optimal channel for peritoneal exploration and could be a useful tool for the diagnosis of PC during peritoneal explorations.
Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. haythem.najah@gmail.com.|Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France. haythem.najah@gmail.com.
Haythem
H
Najah
Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.|Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France.
Réa
R
Lo Dico
Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France.|Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
Anthony
A
Dohan
Department of Anesthesiology, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
Lucy
L
Marry
Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.|Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France.
Clarisse
C
Eveno
Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.|Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France.
Marc
M
Pocard
D000328:Adult; D000368:Aged; D001063:Appendiceal Neoplasms / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary; D003110:Colonic Neoplasms / Q000473:pathology; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008027:Light; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000473:pathology* / Q000556:secondary; D013274:Stomach Neoplasms / Q000473:pathology
D004396:Coloring Agents
Computed virtual chromoendoscopy; Fujinon intelligent chromoendoscopy; Peritoneal carcinomatosis; Peritoneoscopy; Video imaging; Wavelength