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Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions ENDOSCOPY INTERNATIONAL OPEN Krishna, S. G., Swanson, B., Hart, P. A., El-Dika, S., Walker, J. P., McCarthy, S. T., Malli, A., Shah, Z. K., Conwell, D. L. 2016; 4 (11): E1124–E1135

Abstract

Background and aims: Endoscopic ultrasound (EUS)-guided needle-based Confocal Laser Endomicroscopy (nCLE) characteristics of pancreatic cystic lesions (PCLs) have been identified in studies where the gold standard surgical histopathology was available in a minority of patients. There are diverging reports of interobserver agreement (IOA) and paucity of intraobserver reliability (IOR). Thus, we sought to validate current EUS-nCLE criteria of PCLs in a larger consecutive series of surgical patients. Methods: A retrospective analysis of patients who underwent EUS-nCLE at a single center was performed. For calculation of IOA (Fleiss' kappa) and IOR (Cohen's kappa), blinded nCLE-naïve observers (n?=?6) reviewed nCLE videos of PCLs in two phases separated by a 2-week washout period. Results: EUS-nCLE was performed in 49 subjects, and a definitive diagnosis was available in 26 patients. The overall sensitivity, specificity, and accuracy for diagnosing a mucinous PCL were 94?%, 82?%, and 89?%, respectively. The IOA for differentiating mucinous vs. non-mucinous PCL was "substantial" (??=?0.67, 95?%CI 0.57, 0.77). The mean (± standard deviation) IOR was "substantial" (??=?0.78?±?0.13) for diagnosing mucinous PCLs. Both the IOAs and mean IORs were "substantial" for detection of known nCLE image patterns of papillae/epithelial bands of mucinous PCLs (IOA ??=?0.63; IOR ??=?0.76?±?0.11), bright particles on a dark background of pseudocysts (IOA ??=?0.71; IOR ??=?0.78?±?0.12), and fern-pattern or superficial vascular network of serous cystadenomas (IOA ??=?0.62; IOR ??=?0.68?±?0.20). Three (6.1?% of 49) patients developed post-fine needle aspiration (FNA) pancreatitis. Conclusion: Characteristic EUS-nCLE patterns can be consistently identified and improve the diagnostic accuracy of PCLs. These results support further investigations to optimize EUS-nCLE while minimizing adverse events.NCT02516488.

View details for DOI 10.1055/s-0042-116491

View details for Web of Science ID 000388642000002

View details for PubMedID 27853737

View details for PubMedCentralID PMC5110338