Background and Aims
EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common
types of pancreatic cystic lesions (PCLs) have been identified; however, surgical
histopathology was available in a minority of cases. We sought to assess the performance
characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in
a larger series of patients with a definitive diagnosis.
Methods
Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data,
reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n =
6) correlation. After 2 weeks, the assessors reviewed the same images in a different
sequence. A tutorial on available and novel nCLE image patterns was provided before
each review. The performance characteristics of nCLE and the κ statistic for interobserver
agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR,
mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated.
Landis and Koch interpretation of κ values was used.
Results
A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed.
The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs
were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost
perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The
overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas
(SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing
the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92;
and κ = 0.85 ± 0.11 (almost perfect), respectively.
Conclusions
EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy
and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous
PCLs. These preliminary results support larger multicenter studies to evaluate EUS
nCLE. (Clinical trial registration number: NCT02516488.)
Abbreviations:
CEA (carcinoembryonic antigen), CI (confidence interval), CLE (confocal laser endomicroscopy), HGD (high-grade dysplasia), IOA (interobserver agreement), IOR (intraobserver reliability), IPMN (intraductal papillary mucinous neoplasm), IV (intravenous), MCN (mucinous cystic neoplasm), MRI (magnetic resonance imaging), nCLE (needle-based confocal laser endomicroscopy), NET (neuroendocrine tumor), PCL (pancreatic cystic lesion), SCA (serous cystadenoma), SD (standard deviation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2017
Accepted:
March 1,
2017
Received:
November 21,
2016
Footnotes
DISCLOSURE: This study was funded in part by the American College of Gastroenterology pilot research grant (S.K.). 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 Krishna at [email protected]
Identification
Copyright
© 2017 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- ErratumGastrointestinal EndoscopyVol. 87Issue 6
- PreviewIn the October 2017 issue of Gastrointestinal Endoscopy, the article “Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos)” by Somashekar G. Krishna, et al (Gastrointest Endosc 2017;86:644-54.), contains typographical errors in Table 2. The corrected table appears below.
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- Preview
- Pancreas cyst fluid viscocity assesment in the diagnosis of mucinous cytsGastrointestinal EndoscopyVol. 87Issue 6
- PreviewWe read with interest the article by Krishna et al1 about the use of EUS-guided needle-based confocal laser endomicroscopy (nCLE) in differentiating between mucinous and nonmucinous pancreatic cysts. They reported a cohort of patients with 16 mucinous and 13 nonmucinous pancreas cysts to assess the performance characteristics of EUS-guided nCLE, which was found to have a high accuracy. However, in our experience, nCLE is a very expensive evaluation method for daily practice. In differentiating between mucinous and nonmucinous pancreas cysts, determination of the viscosity of the cyst fluid may be useful.
- Full-Text
- Preview
