EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video)

Krishna, Somashekar G.; Hart, Phil A.; DeWitt, John M.; DiMaio, Christopher J.; Kongkam, Pradermchai; Napoléon, Bertrand; Othman, Mohamed O.; Tan, Damien Meng Yew; Strobel, Sebastian; Stanich, Peter P.; Patel, Anand; Luthra, Anjuli; Chan, Megan Q.; Blaszczak, Alecia; Lee, Dana; El-Dika, Samer; McCarthy, Seán; Walker, Jon; Arnold, Christina A.; Porter, Kyle; Conwell, Darwin L.

doi:10.1016/j.gie.2019.09.014

Cited by 47 publications

(53 citation statements)

References 31 publications

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“…nCLE images can differ in each cyst subtype depending on the plane the structures are being examined in. Dr Krishna's recent article recognises this variability and highlights that in IPMN papillary epithelial "width" and "darkness" are the most sensitive and accurate criteria for identifying IPMN with highrisk features [7]. The images in Figure 1 were representative of those obtained during our study.…”

mentioning

confidence: 55%

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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mentioning

confidence: 55%

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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“…Importantly, nCLE was 98% accurate at diagnosing SCA and the IOA and IOR for recognizing the fern pattern (previously known as SVN) were also almost perfect (κ= 0.83; 95% CI, 0.73-0.92; and κ= 0.85 ± 0.11, respectively). The same group performed a post hoc analysis 29 of the EUS-nCLE characteristics of IPMNs. Increased papillary epithelial "width" and "darkness" were the most sensitive (90% [95% CI, 84%-94%] and 91% [95% CI, 85%-95%], respectively) and accurate (85% [95% CI, 78%-90%] and 84% [95% CI, 77%-89%], respectively) variables with substantial (κ = 0.61 [95% CI, 0.51-0.71]) and moderate (κ= 0.55 [95% CI, 0.45-0.65]) IOAs for detecting high-grade dysplasia/adenocarcinoma (HGD-Ca) in cases of IPMN.…”

Section: Review Of the Evidencementioning

confidence: 99%

The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review

Chin

Tan

2021

Clin Endosc

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The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominal imaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs that require surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriately aggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopic examination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE and histological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed the high diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown to improve the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity and mortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes for pancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate management have resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantly improved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of the pancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.

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“…Encouraging results need validation in larger studies, and not always current procedures led to accurate detection of invasive carcinoma, but these methods seem a promising road for the early detection of cancer. Confocal laser endomicroscopy showed to be superior to cyst fluid CEA and cytology, and new parameters (e.g., papillary epithelial width, darkness) may be evaluated to detect high-grade dyplasia in IPMNs [44][45][46][47][48]. For example, evaluation of cyst fluid CEA may differentiate between mucinous and non-mucinous cystic neoplasm (CEA > 192 ng/mL suggests an MCN), yet it is not helpful in distinguishing MCNs versus IPMNs or benign versus HGD lesions [45,[49][50][51][52][53][54][55][56].…”

Section: State-of-the-art Managementmentioning

confidence: 99%

Intraductal Pancreatic Mucinous Neoplasms: A Tumor-Biology Based Approach for Risk Stratification

Nasca

Chiaravalli

Piro

et al. 2020

IJMS

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Pancreatic ductal adenocarcinoma is one of the most lethal human cancers. Its precursor lesions include pancreatic intra-epithelial neoplasia, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm (IPMN). IPMNs usually present as an incidental finding at imaging in 2.6% of the population and, according to the degree of dysplasia, they are classified as low- or high-grade lesions. Since the risk of malignant transformation is not accurately predictable, the management of these lesions is based on morphological and clinical parameters, such as presence of mural nodule, main pancreatic duct dilation, presence of symptoms, or high-grade dysplasia. Although the main genetic alterations associated to IPMNs have been elucidated, they are still not helpful for disease risk stratification. The growing body of genomic and epigenomic studies along with the more recent development of organotypic cultures provide the opportunity to improve our understanding of the malignant transformation process, which will likely deliver biomarkers to help discriminate between low- and high-risk lesions. Recent insights on the topic are herein summarized.

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EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video)

Cited by 47 publications

References 31 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

The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review

Intraductal Pancreatic Mucinous Neoplasms: A Tumor-Biology Based Approach for Risk Stratification

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