Endoscopic ultrasound-guided through-the-needle microforceps biopsy and needle-based confocal laser-endomicroscopy increase detection of potentially malignant pancreatic cystic lesions: A single-center study

Table 1 Baseline characteristics and clinical 24-mo follow-up outcome of included patients

	Total (n = 129)	EUS alone (n = 47)	EUS + FNA/CE/ Cystoscopy (n = 28)	EUS + mFB/nCLE (novel techniques) (n = 54)	P value
Age (yr), median (range)	69 (26-97)	71 (29-97)	78 (49-92)	59 (27-97)	< 0.001a
Sex (female), n (%)	90 (69.8)	33 (70.2)	19 (67.0)	38 (70.4)	0.9694b
Pancreatic cyst location, n (%)					0.6258b
Uncinate process	3 (2.3)			3 (5.6)
Head	46 (35.7)	17 (36.2)	9 (32.1)	20 (37.0)
Neck	13 (10.1)	3 (6.4)	4 (14.3)	6 (11.1)
Body	36 (27.9)	14 (29.8)	8 (28.6)	14 (25.9)
Tail	31 (24.0)	13 (27.7)	7 (25.20)	11 (20.4)
Cyst size (mm), n (%)
< 10 mm	33 (25.6)	29 (61.7)	1 (3.6)	3 (5.6)	< 0.001b
10-30 mm	61 (47.3)	16 (34.0)	19 (67.9)	26 (48.1)
> 30 mm	35 (27.1)	2 (4.3)	8 (28.6)	25 (46.3)
Additional endoscopic procedure used for diagnosis1, n (%)					-
EUS-FNA	21 (16.3)		17 (60.7)	4 (7.4)
CE-EUS	20 (15.5)		11 (39.3)	9 (16.7)
Cystoscopy	27 (20.9)		1 (3.6)	26 (48.1)
mFB	36 (27.9)			36 (66.7)
nCLE	44 (34.1)			44 (81.5)
Pancreatic cyst diagnosis, n (%)					< 0.001b
Malignant2	81 (62.8)	46 (97.9)	19 (67.9)	16 (29.6)
Mucinous cystadenocarcinoma	6 (4.7)	1 (2.1)	4 (14.3)	1 (1.9)
Mucinous cystadenoma	4 (3.1)		1 (3.6)	3 (5.6)
Intraductal papillary mucinous neoplasm	70 (54.3)	45 (95.7)	14 (50.0)	11 (20.4)
Neuroendocrine	1 (0.8)			1 (1.9)
Non-malignant2	48 (37.2)	1 (2.1)	9 (32.1)	38 (70.4)
Serous cystadenoma	46 (35.7)	1 (2.1)	9 (32.1)	36 (66.7)
Pseudocysts	2 (1.6)			2 (3.7)
24-mo follow-up, n (%)					0.0351b
Malignant	28 (21.7)	7 (14.9)	11 (39.3)	10 (18.5)
Non-malignant	101 (78.3)	40 (85.1)	17 (60.7)	44 (81.5)
Positive observed agreement between EUS-guided biopsy vs 24-mo follow-up for malignancy detection, n (%)	70 (54.3)	8 (17.0)	18 (64.3)	44 (81.5)	< 0.001b

^aKruskal-Wallis rank sum test.

^bPearson's Chi-squared test.

¹Additional endoscopic procedures are not mutually exclusive.

²Cases with histopathological confirmation met the Fukuoka criteria.

EUS: Endoscopic ultrasound; EUS-FNA: Endoscopic ultrasound-guided fine needle aspiration; Cystoscopy: Fiberoptic probe cystoscopy; nCLE: Endoscopic ultrasound-guided needle-based confocal laser-endomicroscopy; mFB: Endoscopic ultrasound-guided through-the-needle direct intracystic micro forceps biopsy; CE-EUS: Contrast-enhanced endoscopic ultrasound.