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

Am J Gastroenterol. 2008 Mar;103(3):562-9. doi: 10.1111/j.1572-0241.2007.01670.x. Epub 2007 Dec 5.


Objectives: Standard colonoscopy offers no reliable discrimination between neoplastic and nonneoplastic colorectal lesions. Computed virtual chromoendoscopy with the Fujinon intelligent color enhancement (FICE) system is a new dyeless imaging technique that enhances mucosal and vascular patterns. This prospective trial compared the feasibility of FICE, standard colonoscopy, and conventional chromoendoscopy with indigo carmine in low- and high-magnification modes for determination of colonic lesion histology.

Methods: Sixty-three patients with 150 flat or sessile lesions less than 20 mm in diameter were enrolled. At colonoscopy, each lesion was observed with six different endoscopic modalities: standard colonoscopy, FICE, and conventional chromoendoscopy with indigo carmine (0.2%) dye spraying in both low- and high-magnification modes. Histopathology of all lesions was confirmed by evaluation of endoscopic resection or biopsy specimens. Endoscopic images were stored electronically and randomly allocated to a blinded reader.

Results: Of the 150 polyps, 89 were adenomas and 61 were hyperplastic polyps with an average size of 7 mm. For identifying adenomas, the FICE system with low and high magnifications revealed a sensitivity of 89.9% and 96.6%, specificity of 73.8% and 80.3%, and diagnostic accuracy of 83% and 90%, respectively. Compared with standard colonoscopy, the sensitivity and diagnostic accuracy achieved by FICE were significantly better under both low (P < 0.02) and high (P < 0.03) magnification and were comparable to that of conventional chromoendoscopy.

Conclusions: The FICE system identified morphological details that efficiently predict adenomatous histology. For distinguishing neoplastic from nonneoplastic lesions, FICE was superior to standard colonoscopy and equivalent to conventional chromoendoscopy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colonic Polyps / diagnosis
  • Colonography, Computed Tomographic*
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Coloring Agents
  • Female
  • Humans
  • Image Enhancement
  • Image Processing, Computer-Assisted*
  • Indigo Carmine
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Sensitivity and Specificity


  • Coloring Agents
  • Indigo Carmine