scholarly journals Pancreatic Cysts: Diagnostic Role of EUS-Guided Microforceps Biopsy and Confocal Laser Endomicroscopy

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Darina Kohoutova ◽  
Sameer Zar ◽  
Rudolf Repak ◽  
Panagiotis Vlavianos ◽  
Jan Bures
Keyword(s):  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Cyst Fluid ◽  
Confocal Laser Endomicroscopy ◽  
Diagnostic Tools ◽  
Confocal Laser ◽  
Pancreatic Cysts ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Frequent use of high-quality cross-sectional imaging has led to a significant rise in diagnosis of pancreatic cystic lesions (PCLs). Despite the fact that enormous effort has been put into the research of PCLs within the last two decades and multiple guidelines have been developed, our clinical decision-making especially in regard to mucinous lesions remains limited. Currently, clinical assessment, cross-sectional imaging and EUS with fluid analysis (if appropriate) belong to the standard care in patients with PCLs. For differentiation of mucinous from nonmucinous cysts, the sensitivity of cytological investigation and CEA in the cyst fluid is 42% and 52-79%, respectively. Due to the limited accuracy, further diagnostic tools are warranted. Two EUS-guided approaches have been introduced recently. Through-the-(19-gauge EUS) needle Moray microforceps have been developed, and several studies have acknowledged their contribution to the correct diagnosis as they help to overcome limited cellularity of the EUS-guided cyst fluid aspiration and traditional cytology. Confocal laser endomicroscopy offers real-time images and seems to be a promising method for the diagnosis and differential diagnosis of pancreatic PCLs. Example images of the needle-based confocal laser endomicroscopy criteria for the diagnosis of PCLs have been suggested recently. Before both, Moray microforceps and confocal laser endomicroscopy can be widely accepted, further studies are necessary to determine the real diagnostic yield and the clinical efficacy.

scholarly journals The clinical evaluation of needle-based confocal laser endomicroscopy in the assessment of pancreatic cystic lesion: A pilot study

2017 ◽  
Vol 27 (2) ◽  
pp. 96-102
Author(s):  
Yung Ka Chin ◽  
Christopher Jen Lok Khor ◽  
Brian Kim Poh Goh ◽  
Tony Kiat Hon Lim ◽  
Damien Meng Yew Tan
Keyword(s):  
Adverse Event ◽  
Diagnostic Yield ◽  
Pancreatic Neuroendocrine Tumor ◽  
Final Diagnosis ◽  
Ductal Adenocarcinoma ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
High Morbidity ◽  
Cystic Lesions ◽  
Cross Sectional

Background/aim: Pancreatic cystic lesions are increasingly diagnosed from cross-sectional imaging done for other indications. The challenge lies in the ability to correctly identify the high-risk individuals for resection surgery, which carries high morbidity and mortality. Unfortunately, present diagnostic techniques are suboptimal. Needle-based confocal laser endomicroscopy (nCLE) has been designed to bridge this diagnostic gap. We aim to assess the feasibility and safety of nCLE in the assessment of pancreatic cystic lesions. Methods: We prospectively recruited patients referred for assessment of pancreatic cystic lesions from August 2014 until July 2015. All pancreatic cystic lesions were examined with nCLE miniprobe via endoscopic ultrasound followed by fine-needle aspiration. Information regarding the cysts (morphology, location, fluid analysis etc.) was documented. Adverse event was recorded. Results: Fourteen patients were recruited, six were male with a mean age of 66.5 (range 48–80) years. Only 12 completed nCLE examination of the pancreatic cystic lesions. nCLE imaging was successful in 83.3% (10/12). Average nCLE imaging duration was 5 min 18 s. There was one (10%) adverse event. nCLE impressions were correct in eight cases (five malignant and three benign) compared with final diagnosis. Three patients underwent surgery, histology showed ductal adenocarcinoma, pancreatic neuroendocrine tumor and gastric-subtype of intraductal papillary mucinous neoplasm. The sensitivity and specificity of the nCLE impression when compared with final diagnosis were 83.3% and 75% respectively. The accuracy of nCLE was 80%. Conclusion: Our results have demonstrated that nCLE assessment of pancreatic cystic lesions is safe and feasible. It may complement the existing diagnostic modalities to improve diagnostic yield.

Management of Cystic Neoplasms of the Pancreas

2018 ◽  
Author(s):  
Victoria R Rendell ◽  
Walker A Julliard ◽  
Adam M Awe ◽  
Daniel E Abbott ◽  
Emily R Winslow ◽  
...  
Keyword(s):  
Pancreatic Cyst ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Multidisciplinary Teams ◽  
Pancreatic Cystic Neoplasm ◽  
Cross Sectional ◽  
Management Guidelines ◽  
Imaging Characteristics ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The diagnosis of pancreatic cystic lesions is increasingly common. The majority of pancreatic cysts are now diagnosed incidentally on cross-sectional imaging. Lack of clear evidence-based guidelines and overall poor understanding of the natural history of pancreatic cysts contribute to complexity of managing patients with pancreatic cysts. Pancreatic cystic neoplasm types differ in their presentation, histologic features, imaging characteristics, and predisposition to develop invasive malignancy. The diagnostic strategies to determine cyst type and presence of malignancy—cross-sectional imaging, endoscopic ultrasonography, and analyses of pancreatic cyst fluid aspirates—have improved over time. However, accurate characterization of cysts remains challenging. Several large groups, including the American College of Radiology, the American Gastroenterological Association, the European Study Group on Cystic Tumours of the Pancreas, and the International Association of Pancreatology, have released cyst management guidelines or recommendations that have important differences. In this review, we provide an overview of the most common pancreatic cystic neoplasm, evaluate recent advancements in diagnostic techniques, and compare current management guidelines. This review contains 7 figures, 5 tables, and 77 references. Key Words: intraductal papillary mucinous neoplasm, management guidelines, multidisciplinary teams, mucinous cystic neoplasm, pancreatic cyst, pancreatic cystic neoplasm, serous cystadenoma, solid pseudopapillary neoplasm, surgical oncology 

scholarly journals Needle-Based Confocal Laser Endomicroscopy: A New Promising Armamentarium for Diagnostic Endoscopic Ultrasound

2019 ◽  
Vol 10 (02) ◽  
pp. 137-140
Author(s):  
Jimil Shah ◽  
Surinder S Rana
Keyword(s):  
Endoscopic Ultrasound ◽  
Pancreatic Cyst ◽  
Colonic Polyps ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Criteria For Diagnosis ◽  
Subepithelial Lesions ◽  
Epithelial Lesions

AbstractWith increasing use of cross-sectional imaging in diagnosis of various diseases, incidence of asymptomatic pancreatic cyst has increased dramatically in last decade. In management of such asymptomatic pancreatic cyst differentiation of pre-malignant cyst and benign cyst remains an utmost important parameter. Though various endoscopic ultrasound (EUS) criteria have been developed, differentiation between these two entities still remains a challenge in many patients. Confocal laser endomicroscopy (CLE) has shown promising results in diagnosis of various gastrointestinal cancers and colonic polyps. However, CLE criteria have not been prospectively validated in asymptomatic pancreatic cyst to differentiate premalignant vs benign cysts. Similarly, CLE criteria are also not defined for diagnosis of various gastric sub-epithelial lesions. In this news and views we have discussed two important articles regarding role of needle based CLE (nCLE) in these lesions. While one is a multicentric trial which prospectively validates previously defined nCLE criteria for characterizing pancreatic cystic lesion, second developed criteria for diagnosis of various gastric subepithelial lesions based on nCLE findings.

Incidental Pancreatic Cysts on Cross-Sectional Imaging

2021 ◽  
Vol 59 (4) ◽  
pp. 617-629
Author(s):  
Shannon M. Navarro ◽  
Michael T. Corwin ◽  
Douglas S. Katz ◽  
Ramit Lamba
Keyword(s):  
Pancreatic Cysts ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Incidental Pancreatic Cysts

Brush Cytology Performance for the Assessment of Biliopancreatic Strictures

2019 ◽  
Vol 64 (4) ◽  
pp. 344-351 ◽  
Author(s):  
Pedro Pereira ◽  
Rui Morais ◽  
Filipe Vilas-Boas ◽  
Eduardo Rodrigues-Pinto ◽  
Joanne Lopes ◽  
...  
Keyword(s):  
Positive Result ◽  
Diagnostic Yield ◽  
Brush Cytology ◽  
Cross Sectional ◽  
Factors Associated ◽  
Tertiary Center ◽  
Two Factors ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Yield Sensitivity

Introduction: Brush cytology is commonly used during endoscopic retrograde cholangiopancreatography for the diagnostic evaluation of biliopancreatic strictures. However, since the overall sensitivity of brush cytology is poor, the exclusion of malignancy is difficult. Recognition of factors related to the patient, technique or lesion may help improve the diagnostic yield of brush cytology. The objective of this study was to evaluate the diagnostic yield of brush cytology in the assessment of biliopancreatic strictures and identify predictive factors associated with a positive diagnosis of malignancy. Methods: Retrospective study that evaluated all consecutive patients that underwent brush cytology for the investigation of biliopancreatic strictures in a tertiary center, between January 2012 and January 2018. Results: One hundred and sixty-five patients that underwent 182 procedures were included. A diagnosis of malignancy was confirmed in 110 patients (66.7%), of whom 62 had positive brush cytology (sensitivity 53.7%, specificity 98.5%, accuracy 69.8%). On the multivariate analysis, age ≥68 years (OR 4.83, 95% CI 1.04–22.37) and lesions suspicious of metastasis on cross-sectional imaging (OR 8.58, 95% CI 1.70–43.38) were independently associated with a positive result. Subanalysis of the patients presenting with these two factors (n = 26) revealed an increase in the diagnostic yield (sensitivity 80.8%). Conclusion: Age ≥68 years and lesions suspicious of metastasis on cross-sectional imaging are independent factors associated with a positive result. Patient selection taking these factors into account may increase the diagnostic yield of brush cytology.

scholarly journals Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-31 ◽  
Author(s):  
Alessandro Fugazza ◽  
Federica Gaiani ◽  
Maria Clotilde Carra ◽  
Francesco Brunetti ◽  
Michaël Lévy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
High Sensitivity ◽  
Gastric Neoplasms ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Pancreatic Cysts ◽  
Specific Operator ◽  
Sensitivity Specificity

Confocal laser endomicroscopy (CLE) is an endoscopic-assisted technique developed to obtain histopathological diagnoses of gastrointestinal and pancreatobiliary diseases in real time. The objective of this systematic review is to analyze the current literature on CLE and to evaluate the applicability and diagnostic yield of CLE in patients with gastrointestinal and pancreatobiliary diseases. A literature search was performed on MEDLINE, EMBASE, Scopus, and Cochrane Oral Health Group Specialized Register, using pertinent keywords without time limitations. Both prospective and retrospective clinical studies that evaluated the sensitivity, specificity, or accuracy of CLE were eligible for inclusion. Of 662 articles identified, 102 studies were included in the systematic review. The studies were conducted between 2004 and 2015 in 16 different countries. CLE demonstrated high sensitivity and specificity in the detection of dysplasia in Barrett’s esophagus, gastric neoplasms and polyps, colorectal cancers in inflammatory bowel disease, malignant pancreatobiliary strictures, and pancreatic cysts. Although CLE has several promising applications, its use has been limited by its low availability, high cost, and need of specific operator training. Further clinical trials with a particular focus on cost-effectiveness and medicoeconomic analyses, as well as standardized institutional training, are advocated to implement CLE in routine clinical practice.

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