Original articlePancreas, biliary tract, and liverEndoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions
Section snippets
Methods
The Ohio State University Wexner Medical Center Institutional Review Board approved this prospective study. All authors had access to the study data and reviewed and approved the final manuscript.
Subjects were referred for EUS–fine-needle aspiration (FNA) based on the treating physician and current guidelines for managing PCLs.1 The Comparison of Confocal Laser Endomicroscopy IN vivo Diagnosis and EX vivo (INDEX) Study was performed during a 3.5-year study period from June 1, 2015, to December
Cohort Characteristics
As shown in Figure 1, EUS-nCLE was performed in 144 subjects. The mean age of all subjects who underwent EUS-nCLE was 60.2 years (SD, 14.3 y), the mean size of the dominant cyst was 36.4 mm (SD, 15.7 mm), and the mean duration of EUS-nCLE image acquisition was 7.3 minutes (SD, 2.8 min). Other characteristics of this cohort are shown in Supplementary Table 3.
Comparison of Mucinous and Nonmucinous Pancreatic Cystic Lesions
Among subjects with surgical histopathology (n = 65), univariate analysis (Table 1) showed that patients with mucinous PCLs were older,
Discussion
The management of PCLs is challenging with increasing incidental detection of PCLs, divergent management guidelines, and lack of optimal diagnostics used in the current standard of care. This is problematic for the accurate classification of mucinous vs nonmucinous PCLs. In this report of the INDEX study, which comprises a large number of subjects who underwent EUS-nCLE and surgical resection of PCLs, we show that specific endomicroscopy image patterns have higher diagnostic accuracy for
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Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions
2022, PancreatologyCitation Excerpt :Pseudocysts were diagnosed with high specificity (96.2%) and sensitivity (87.2%), substantial IOR (k = 0.62), and moderate IOA (k = 0.57) in our study. Four studies previously reported similar high specificity with EUS-nCLE for pseudocysts, but with lower sensitivity (43%–67%), and better IOA (k, 0.79–1) and IOR (k, 0.78–0.91) [9,14,16,18]. Differences across study results may be because nCLE features of pseudocysts (auto-fluorescing inflammatory cells against a dark background, Fig. 1) are sometimes mimicked by MCNs when inflammatory cells are present and epithelial bands are unidentifiable due to epithelial denudation/atrophy [24,25].
Efficacy and safety of EUS-guided through-the-needle microforceps biopsy sampling in categorizing the type of pancreatic cystic lesions
2022, Gastrointestinal EndoscopyCitation Excerpt :The outcomes of these studies, however, focused on differentiating between mucinous cysts and nonmucinous cysts rather than on categorizing the types of PCLs. Accordingly, other diagnostic tools for characterizing the types of PCLs have been introduced, including the needle-based confocal laser endomicroscopy7,30 and a diagnostic algorithm for characterizing PCLs based on needle-based confocal laser endomicroscopy images.31 Recent studies also showed promising results of needle-based confocal laser endomicroscopy in terms of risk stratification of IPMNs.8,9
Conflicts of interest The authors disclose no conflicts.
Funding This study was funded by an American College of Gastroenterology Clinical Research grant.