ACCURACY OF NEEDLE-BASED CONFOCAL LASER ENDOMICROSCOPY (NCLE) IN THE DISCRIMINATION OF MUCINOUS VS NON MUCINOUS PANCREATIC CYSTIC LESIONS: AN ITALIAN MULTICENTER PROSPECTIVE STUDY

2020 ◽  
Author(s):  
H Bertani ◽  
R Pezzilli ◽  
F Pigò ◽  
M Bruno ◽  
CD Angelis ◽  
...  
Keyword(s):  
Prospective Study ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cystic Lesions ◽  
Multicenter Prospective Study

scholarly journals Needle-based confocal laser endomicroscopy of pancreatic cystic lesions: a prospective multicenter validation study in patients with definite diagnosis

Endoscopy ◽  
2018 ◽  
Vol 51 (09) ◽  
pp. 825-835 ◽  
Author(s):  
Bertrand Napoleon ◽  
Maxime Palazzo ◽  
Anne-Isabelle Lemaistre ◽  
Fabrice Caillol ◽  
Laurent Palazzo ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Needle Aspiration ◽  
Serous Cystadenoma ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cystic Lesions ◽  
Ultrasound Guided ◽  
Cystic Fluid ◽  
Post Procedure ◽  
Mean Size

Abstract Background Needle-based confocal laser endomicroscopy (nCLE) enables observation of the inner wall of pancreatic cystic lesions (PCLs) during an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). This study prospectively evaluated the diagnostic performance of nCLE for large, single, noncommunicating PCLs using surgical histopathology or EUS-FNA cytohistopathology as a reference diagnosis. Methods From April 2013 to March 2016, consecutive patients referred for EUS-FNA of indeterminate PCLs without evidence of malignancy or chronic pancreatitis were prospectively enrolled at five centers. EUS-FNA and nCLE were performed and cystic fluid was aspirated for cytohistopathological and carcinoembryonic antigen (CEA) analysis. The diagnostic performance of nCLE was assessed against the reference standard and compared with that of EUS and CEA. This study was registered on ClinicalTrials.gov (NCT01563133). Results 206 patients underwent nCLE and 78 PCLs (mean size 40 mm, range 20 – 110 mm) had reference diagnoses (53 premalignant and 25 benign PCLs). Post-procedure pancreatitis occurred in 1.3 % of the patients. nCLE was conclusive in 71 of the 78 cases (91 %). The sensitivies and specifities of nCLE for the diagnosis of serous cystadenoma, mucinous PCL, and premalignant PCL were all ≥ 0.95 (with 95 % confidence interval from 0.85 to 1.0). The AUROC was significantly larger for nCLE than for CEA or EUS. Conclusions nCLE had excellent diagnostic performance that surpassed that of CEA and EUS for the diagnosis of large, single, noncommunicating PCLs. The nCLE procedure should be considered in patients with indeterminate PCLs to ensure a more specific diagnosis.

scholarly journals Probe-Based Confocal Laser Endomicroscopy for Indeterminate Biliary Strictures: Refinement of the Image Interpretation Classification

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Michel Kahaleh ◽  
Marc Giovannini ◽  
Priya Jamidar ◽  
S. Ian Gan ◽  
Paola Cesaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Interobserver Agreement ◽  
Image Interpretation ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Inflammatory Conditions ◽  
Paris Classification ◽  
Low Sensitivity ◽  
Duct Stricture

Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives.Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences.Results. Overall accuracy was 82.5% (n=40retrospectively diagnosed) versus 81% (n=89prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k=0.37).Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.

scholarly journals A new needle-based confocal laser endomicroscopy pattern of malignant pancreatic mucinous cystic lesions (with video)

2020 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Aiming Yang ◽  
Yunlu Feng ◽  
Xiaoyan Chang ◽  
Yu Zhao ◽  
Dong Wu ◽  
...  
Keyword(s):  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cystic Lesions

Needle-Based Confocal Laser Endomicroscopy Examination of Autoimmune Pancreatitis With Cystic Lesions (With Video)

Pancreas ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. e28-e29
Author(s):  
Yunlu Feng ◽  
Yu Zhao ◽  
Zhilan Meng ◽  
Xi Wu ◽  
Tao Guo ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cystic Lesions
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