BACKGROUND & AIMS Imaging patterns from endoscopic ultrasound (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) have been associated with specific pancreatic cystic lesions (PCLs). We compared the accuracy of EUS with nCLE in differentiating mucinous from nonmucinous PCLs with that of measurement of carcinoembryonic antigen (CEA) and cytology analysis. METHODS We performed a prospective study of 144 consecutive patients with a suspected PCL (≥20 mm) who underwent EUS with fine-needle aspiration of pancreatic cysts from June 2015 through December 2018 at a single center; 65 patients underwent surgical resection. Surgical samples were analyzed by histology (reference standard). During EUS, the needle with the miniprobe was placed in the cyst, which was analyzed by nCLE. Fluid was aspirated and analyzed for level of CEA and by cytology. We compared the accuracy of nCLE in differentiating mucinous from nonmucinous lesions with that of measurement of CEA and cytology analysis. RESULTS The mean size of dominant cysts was 36.4 ± 15.7 mm and the mean duration of nCLE imaging was 7.3 ± 2.8 min. Among the 65 subjects with surgically resected cysts analyzed histologically, 86.1% had at least 1 worrisome feature based on the 2012 Fukuoka criteria. Measurement of CEA and cytology analysis identified mucinous PCLs with 74% sensitivity, 61% specificity, and 71% accuracy. EUS with nCLE identified mucinous PCLs with 98% sensitivity, 94% specificity, and 97% accuracy. nCLE was more accurate in classifying mucinous vs nonmucinous cysts than the standard method (P < .001). The overall incidence of postprocedure acute pancreatitis was 3.5% (5 of 144); all episodes were mild, based on the revised Atlanta criteria. CONCLUSIONS In a prospective study, we found that analysis of cysts by nCLE identified mucinous cysts with greater accuracy than measurement of CEA and cytology analysis. EUS with nCLE can be used to differentiate mucinous from nonmucinous PCLs. ClincialTrials.gov no: NCT02516488.

中文翻译：

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内窥镜超声引导共聚焦激光内镜检查提高了胰腺囊性病变鉴别的准确性。

背景和目的 内窥镜超声 (EUS) 引导的基于针的共聚焦激光内镜 (nCLE) 的成像模式与特定的胰腺囊性病变 (PCL) 相关。我们比较了 EUS 和 nCLE 在区分粘液性和非粘液性 PCL 方面的准确性以及癌胚抗原 (CEA) 测量和细胞学分析的准确性。方法 我们对 2015 年 6 月至 2018 年 12 月在单个中心接受 EUS 和胰腺囊肿细针抽吸术的 144 名疑似 PCL（≥20 mm）患者进行了一项前瞻性研究；65例患者接受了手术切除。通过组织学（参考标准）分析手术样本。在 EUS 期间，带有微型探针的针头被放置在囊肿中，通过 nCLE 进行分析。吸出液体并通过细胞学分析 CEA 水平。我们将 nCLE 在区分粘液性和非粘液性病变方面的准确性与 CEA 测量和细胞学分析的准确性进行了比较。结果 显性囊肿的平均大小为 36.4 ± 15.7 mm，nCLE 成像的平均持续时间为 7.3 ± 2.8 min。在组织学分析的 65 名手术切除囊肿的受试者中，根据 2012 年福冈标准，86.1% 的受试者至少有 1 个令人担忧的特征。CEA 的测量和细胞学分析以 74% 的灵敏度、61% 的特异性和 71% 的准确度确定了粘液性 PCL。具有 nCLE 的 EUS 以 98% 的灵敏度、94% 的特异性和 97% 的准确度识别出粘液性 PCL。nCLE 在分类粘液性和非粘液性囊肿方面比标准方法更准确 (P < .001)。术后急性胰腺炎的总发病率为 3.5%（144 人中有 5 人）；根据修订后的亚特兰大标准，所有发作都是轻微的。结论 在一项前瞻性研究中，我们发现通过 nCLE 分析囊肿比 CEA 测量和细胞学分析更准确地识别出粘液性囊肿。EUS 与 nCLE 可用于区分粘液性和非粘液性 PCL。ClincialTrials.gov 编号：NCT02516488。