Diagnostic accuracy of linked color imaging and white light imaging for early gastric cancer and gastrointestinal metaplasia: a systematic review and meta-analysis.

Background: Conventional white light imaging (WLI) frequently misses gastric cancer, resulting in a high rate of undiagnosed cases. This study compares the effectiveness of linked color imaging (LCI) and WLI in detecting early gastric cancer and gastrointestinal metaplasia, aiming to improve clinical diagnostic practices through evidence-based medical insights. Methods: The QUADAS-2 tool evaluated the quality of the studies. Additionally, methods like Split Component Synthesis (SCS) were utilized to evaluate the diagnostic performance of LCI and WLI. Results: Eleven studies involving a total of 7836 patients were included in the meta-analysis. Comparative analysis revealed that LCI demonstrated a statistically significant superiority over WLI in terms of the detection rates of EGC and GIM (detection rate of EGC: LCI vs WLI, 85% vs. 56.7%, p=0.004, OR 4.78, 95% CI 2.33-9.82, I2 = 71%; detection rate of GIM: LCI vs WLI, 88.9% vs. 40.1%, p=0.0003, OR 9.94, 95% CI 5.59-17.68, I2 = 71%). Additionally, LCI exhibited better sensitivity and specificity for the diagnosis of EGC and GIM compared to WLI. For the entire cohort, the sensitivity of LCI for EGC detection was 80% (95% CI 71%-86%) with a specificity of 82% (95% CI 63%-92%), while for GIM detection, the sensitivity was 87% (95% CI 81%-92%) with a specificity of 85% (95% CI 77%-91%). Conclusions: The detection efficiency of LCI for EGC and GIM is better than that of WLI, and LCI is recommended as the main screening method for EGC and GIM. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023452140.