Background and Aims
Diagnosis of pancreatic cystic lesions (PCLs) remains challenging. EUS with FNA is
limited by sampling error and nondiagnostic cytology. Needle-based confocal laser
endomicroscopy (nCLE) performed during EUS can be used to improve diagnostic yield
via FNA by providing in vivo histology of PCLs. However, the interobserver agreement
(IOA) of nCLE of PCLs has yet to be studied.
Methods
Fifteen deidentified nCLE video clips of PCLs were sent to 6 interventional endoscopists
at 5 institutions. Six variables were assessed for IOA: presence or absence of (1)
vessels, (2) villi, (3) dark clumps, (4) reticular pattern, (5) acinar cells pattern, and (6) debris. PCL interpretation was categorized as mucinous, serous,
pseudocyst, malignant, or indeterminate and final diagnosis as benign, malignant,
or indeterminate.
Results
IOA ranged from “poor” to “fair.” The K statistics were –.04 (SE = .05) for vessels,
.16 (SE = .07) for villi, .22 (SE = .06) for dark clumps, .13 (SE = .06) for reticular
pattern, .14 (SE = .06) for acinar cells pattern, .06 (SE = .06) for debris, .15 (SE = .03) for interpretation, .13 (SE =
.05) for final diagnosis, and .19 (SE = .05) for image quality. The final diagnosis
was malignant (10), benign (13), and indeterminate (2). The mean accuracy of the observers
was 46%, with the lowest being 20% and highest being 67%.
Conclusions
The IOA and accuracy for PCL diagnosis were low. The results of this study support
the need to identify and validate imaging criteria to determine whether nCLE has diagnostic
value for pancreatic pathology. (Clinical trial registration number: NCT02166086.)
Abbreviations:
IOA (interobserver agreement), nCLE (needle-based confocal endomicroscopy), PCL (pancreatic cyst lesion)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 14, 2015
Accepted:
August 15,
2015
Received:
April 15,
2015
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: M. Kahaleh: Consultant for Boston Scientific and Xlumena; preceptorship for MaunaKea Tech and Concordia; research grant recipient for Boston Scientific, Fuji, Pentax, MI Tech, EMcision, ASPIRE Bariatrics, GI Dynamics, W.L. Gore Associates, Cook Endoscopy, Apollo Endosurgery, MaunaKea Tech, NinePoint Medical, and Merit Medical; A. Sethi: Consultant for Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Kahaleh at [email protected] .
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy.
