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Published in: Surgical Endoscopy 6/2016

01-06-2016 | Dynamic Manuscript

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

Authors: Bertrand Napoleon, Anne-Isabelle Lemaistre, Bertrand Pujol, Fabrice Caillol, Damien Lucidarme, Raphaël Bourdariat, Blandine Morellon-Mialhe, Fabien Fumex, Christine Lefort, Vincent Lepilliez, Laurent Palazzo, Geneviève Monges, Flora Poizat, Marc Giovannini

Published in: Surgical Endoscopy | Issue 6/2016

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Abstract

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 .

Methods

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.

Results

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).

Conclusions

Based on this newly completed atlas of interpretation criteria, nCLE could facilitate the diagnosis of pancreatic cystic lesion types.
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Metadata
Title
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
Authors
Bertrand Napoleon
Anne-Isabelle Lemaistre
Bertrand Pujol
Fabrice Caillol
Damien Lucidarme
Raphaël Bourdariat
Blandine Morellon-Mialhe
Fabien Fumex
Christine Lefort
Vincent Lepilliez
Laurent Palazzo
Geneviève Monges
Flora Poizat
Marc Giovannini
Publication date
01-06-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4510-5

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