Probe based confocal laser endomicroscopy of the pancreatobiliary system

Table 1 Interpretation of findings on confocal endomicrosopy and findings on confocal laser endomicroscopy for specific pancreatic lesions

Findings on CLE	Interpretation
Normal
Reticular pattern seen in normal tissue and smaller than blood vessels[6]	Lymphatics
Thick white bands[52]	Angiogenesis
Reticular arrangement of dark-gray bands on a light-gray background and normal vessels (thin and regular) and no visible glands[9]	Normal common bile duct chorion
Black clumps[69]	Areas of decreased fluorescein uptake
Large white streaks/bands[69]	Dilated, tortuous blood vessels
Loss of mucosal architecture[6,69]	Fibrosis
Multiple thin white bands[15]	Vascular congestion
Thin dark bands forming a reticular pattern (diameter < 20 μm)	Submucosal collagen network
Thin white bands (diameter < 20 μm)	Small caliber blood vessels
Light grey background	Lymphatic sinuses
Abnormal
Thick collagen bundles	Desmoplasia (growth of fibrous and connective tissue)
Thick white bands (diameter > 20 μm)	Malignant bile duct stricture
Multiple white bands	Inflammatory bile duct stricture
Dark clumps and epithelium	Malignancy
Type of pancreatic lesion	Characteristics on nCLE
Exocrine adenocarcinomas	Dark cells aggregates with pseudo-glandular aspects
	Straight hyperdense elements more or less thick corresponding to tumoral fibrosis
Tumors with acini cells and neuroendocrine tumors	Very dense network of small vessels on a dark background
Serous cystadenoma	Highly dense and dynamic network of blood capillaries, present in the superficial layer of the cyst wall, superficial vascular network, (pathognomonic)
Intraductal papillary mucinous neoplasm	Papillae characterized by two epithelial borders surrounding a bright vascular flow
Mucinous cystadenoma neoplasm	An epithelial border lined the cyst wall, with or without deep blood vessels, and without papillary organization

CLE: Confocal laser endomicroscopy; nCLE: Needle CLE.