Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions

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

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View details for PubMedID 27853737

View details for PubMedCentralID PMC5110338