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Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study GASTROINTESTINAL ENDOSCOPY Krishna, S. G., Brugge, W. R., Dewitt, J. M., Kongkam, P., Napoleon, B., Robles-Medranda, C., Tan, D., El-Dika, S., McCarthy, S., Walker, J., Dillhoff, M. E., Manilchuk, A., Schmidt, C., Swanson, B., Shah, Z. K., Hart, P. A., Conwell, D. L. 2017; 86 (4): 644-+

Abstract

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.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 ? 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 ? values was used.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 ? = 0.81 (almost perfect); 95% CI, 0.71-0.90; and ? = 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 ? = 0.83 (almost perfect); 95% CI, 0.73-0.92; and ? = 0.85 ± 0.11 (almost perfect), respectively.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.).

View details for DOI 10.1016/j.gie.2017.03.002

View details for Web of Science ID 000410624300012

View details for PubMedID 28286093