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In vivo characterization of pancreatic cystic lesions by needle-based confocal laser endomicroscopy (nCLE): proposition of a comprehensive nCLE classification confirmed by an external retrospective evaluation

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Abstract

Background and aims

The differential diagnosis of solitary pancreatic cystic lesions is sometimes difficult. Needle-based confocal laser endomicroscopy (nCLE) performed during endoscopic ultrasound–fine-needle aspiration (EUS-FNA) enables real-time imaging of the internal structure of such cysts. Criteria have already been described for serous cystadenoma and intraductal papillary mucinous neoplasm (IPMN). The aims of the study were to determine new nCLE criteria for the diagnosis of pancreatic cystic lesions, to propose a comprehensive nCLE classification for the characterization of those lesions, and to carry out a first external retrospective validation .

Methods

Thirty-three patients with a lone pancreatic cystic lesion were included (CONTACT 1 study). EUS-FNA was combined with nCLE. Diagnosis was based on either pathology result (Group 1, n = 20) or an adjudication committee consensus (Group 2, n = 13). Six investigators, unblinded, studied cases from Group 1 and identified nCLE criteria for mucinous cystic neoplasm (MCN), pseudocyst (PC), and cystic neuroendocrine neoplasm (NEN). Four external reviewers assessed, blinded, the yield and interobserver agreement for the newly identified (MCN, PC) and previously described (IPMN, SC) criteria in a subset of 31 cases.

Results

New nCLE criteria were described for MCN (thick gray line), PC (field of bright particles), and cystic NEN (black neoplastic cells clusters with white fibrous areas). These criteria correlated with the histological features of the corresponding lesions. In the retrospective validation, a conclusive nCLE result was obtained for 74 % of the cases (87 % “true” and 13 % “false” with respect to the final diagnosis). On this limited case series, the nCLE criteria showed a trend for high diagnostic specificity (>90 % for mucinous cysts, 100 % for non-mucinous cysts).

Conclusions

Based on this newly completed atlas of interpretation criteria, nCLE could facilitate the diagnosis of pancreatic cystic lesion types.

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Acknowledgments

We would like to thank all procedural nurses and staff for their assistance during procedures. We would like to thank Cécile Redon and Claire Burucoa from Mauna Kea Technologies for additional logistical support during the trial.

Funding

This study has been funded by Mauna Kea Technologies.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hôpital Privé Jean Mermoz, Générale de Santé, 4 rue Jacqueline Auriol, 69008, Lyon, France

    Bertrand Napoleon, Bertrand Pujol, Fabien Fumex, Christine Lefort & Vincent Lepilliez

  2. Department of Biopathology, Centre Léon Bérard, Lyon, France

    Anne-Isabelle Lemaistre & Blandine Morellon-Mialhe

  3. Department of Hepato-gastroenterology, Institut Paoli Calmettes, Marseille, France

    Fabrice Caillol & Marc Giovannini

  4. Medico-surgical Department of Hepato-gastroenterology, Hôpital Saint-Philibert, Lomme-lès-Lille, France

    Damien Lucidarme

  5. Department of Digestive Surgery, Hôpital Privé Jean Mermoz, Générale de Santé, Lyon, France

    Raphaël Bourdariat

  6. Department of Gastroenterology, Clinique du Trocadéro, Paris, France

    Laurent Palazzo

  7. Department of Biopathology, Institut Paoli Calmettes, Marseille, France

    Geneviève Monges & Flora Poizat

Authors
  1. Bertrand Napoleon
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  2. Anne-Isabelle Lemaistre
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  3. Bertrand Pujol
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  7. Blandine Morellon-Mialhe
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  11. Laurent Palazzo
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  12. Geneviève Monges
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  13. Flora Poizat
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  14. Marc Giovannini
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Corresponding author

Correspondence to Bertrand Napoleon.

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Disclosures

Dr. Napoleon reports non-financial support from Mauna Kea Technologies, Grants from Mauna Kea Technologies, personal fees from Mauna Kea Technologies, during the conduct of the study; personal fees from Mauna Kea Technologies, outside the submitted work. Dr. Lemaistre reports personal fees from Mauna Kea Technologies, during the conduct of the study; personal fees from Mauna Kea Technologies, outside the submitted work. Dr. Pujol reports non-financial support from Mauna Kea Technologies, Grants from Mauna Kea Technologies, personal fees from Mauna Kea Technologies, during the conduct of the study. Dr. Caillol reports non-financial support from Mauna Kea Technologies, Grants from Mauna Kea Technologies, during the conduct of the study. Dr. Lucidarme reports non-financial support from Mauna Kea Technologies, Grants from Mauna Kea Technologies, during the conduct of the study. Drs. Bourdariat, Fumex, Lefort, Lepilliez, Monges, Morellon-Mialhe, and Poizat have nothing to disclose. Dr. Palazzo reports non-financial support from Mauna Kea Technologies, during the conduct of the study. Dr. Giovannini reports non-financial support from Mauna Kea Technologies, Grants from Mauna Kea Technologies, during the conduct of the study.

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Napoleon, B., Lemaistre, AI., Pujol, B. et al. In vivo characterization of pancreatic cystic lesions by needle-based confocal laser endomicroscopy (nCLE): proposition of a comprehensive nCLE classification confirmed by an external retrospective evaluation. Surg Endosc 30, 2603–2612 (2016). https://doi.org/10.1007/s00464-015-4510-5

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  • DOI: https://doi.org/10.1007/s00464-015-4510-5

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