Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions

Krishna, Somashekar G.; Hart, Phil A.; Malli, Ahmad; Kruger, Andrew J.; McCarthy, Seán; El-Dika, Samer; Walker, Jon; Dillhoff, Mary; Manilchuk, Andrei; Schmidt, Carl; Pawlik, Timothy M.; Porter, Kyle; Arnold, Christina A.; Cruz‐Monserrate, Zobeida; Conwell, Darwin L.

doi:10.1016/j.cgh.2019.06.010

Cited by 76 publications

(92 citation statements)

References 25 publications

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“…EUS-nCLE findings correlated with final diagnosis (based on imaging, cytology and multidisciplinary team review) in 43/56 (77 %) of cases, compared with 37/56 (66 %) for cytology alone (P = 0.12). The overall findings were similar to previous nCLE studies of patients with cystic lesions of the pancreas [1][2][3][4][5] including Dr Krishna's recent US multicentre study (74 % sensitivity, 61 % specificity, 71 % accuracy) [6].…”

supporting

confidence: 87%

Response to letter: Endoscopic ultrasound-guided confocal endomicroscopy requires high-quality imaging and interpretation for diagnostic evaluation of pancreatic cystic lesions

2020

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supporting

confidence: 87%

Response to letter: Endoscopic ultrasound-guided confocal endomicroscopy requires high-quality imaging and interpretation for diagnostic evaluation of pancreatic cystic lesions

2020

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“…The INDEX study showed that 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 [8].…”

Section: %)mentioning

confidence: 83%

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

et al. 2020

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Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs. Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis). Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %). Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

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“…The overall incidence of postprocedure acute pancreatitis was 3.5%, and all episodes were mild. 6 In another study comprising 78 PCLs published recently, Napoleon et al 7 reported that the sensitivities and specificities of nCLE for the diagnosis of all PCL groups were higher than 0.95. They evaluated the diagnostic performance of nCLE using surgical histopathologic analysis or EUS-FNA cytohistopathologic analysis as reference diagnosis.…”

mentioning

confidence: 93%

“…4,5 The studies have established nCLE as a feasible and safe imaging modality for differentiating mucinous from nonmucinous PCLs ( Table 1). Most recently, Krishna et al 6 published the results of the INDEX study, which comprises the largest number of study participants who have undergone EUS-guided nCLE and surgical resection of PCLs so far. The authors compared the accuracy of nCLE in differentiating mucinous from nonmucinous lesions with that of measurement of CEA and cytologic analysis validated by surgery.…”

mentioning

confidence: 99%

EUS-guided confocal laser endomicroscopy: Can we use thick and wide for diagnosis of early cancer?

Brugge

2020

Gastrointestinal Endoscopy

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Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions

Cited by 76 publications

References 25 publications

Response to letter: Endoscopic ultrasound-guided confocal endomicroscopy requires high-quality imaging and interpretation for diagnostic evaluation of pancreatic cystic lesions

Response to letter: Endoscopic ultrasound-guided confocal endomicroscopy requires high-quality imaging and interpretation for diagnostic evaluation of pancreatic cystic lesions

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

EUS-guided confocal laser endomicroscopy: Can we use thick and wide for diagnosis of early cancer?

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