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 .
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.
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).
Based on this newly completed atlas of interpretation criteria, nCLE could facilitate the diagnosis of pancreatic cystic lesion types.
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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.
This study has been funded by Mauna Kea Technologies.
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, A., 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) doi:10.1007/s00464-015-4510-5
- Pancreatic cysts
- Needle-based confocal laser endomicroscopy