Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2017; 23(18): 3338-3348
Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3338
In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study
Somashekar G Krishna, Rohan M Modi, Amrit K Kamboj, Benjamin J Swanson, Phil A Hart, Mary E Dillhoff, Andrei Manilchuk, Carl R Schmidt, Darwin L Conwell
Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Rohan M Modi, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Amrit K Kamboj, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Benjamin J Swanson, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Mary E Dillhoff, Carl R Schmidt, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Andrei Manilchuk, Deparment of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Krishna SG designed the protocol, performed all EUS-nCLE and ex vivo CLE procedures, in vivo and ex vivo CLE interpretation, wrote the manuscript, and edited images; Modi RM assisted with background literature, wrote the manuscript, in vivo and ex vivo CLE interpretation, and edited images; Kamboj AK assisted with background literature search, and edited images; Swanson BJ assisted with ex vivo CLE image acquisition, provided pathological interpretation, and edited images; Hart PA performed critical revision of manuscript; Dillhoff ME, Manilchuk A and Schmidt CR performed pancreatic surgeries and provided resected specimens for ex vivo CLE; Conwell DL performed critical revision of manuscript.
Supported by American College of Gastroenterology Pilot Research Grant. The Gastroflex UHD probe for the ex vivo evaluation was provided by Cellvizio, Mauna Kea Technologies, Paris, France.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of The Ohio State University, Columbus, United States.
Clinical trial registration statement: The clinical trial is registered with ClinicalTrials.gov, using identifier NCT02516488. Details can be found at https://clinicaltrials.gov/ct2/show/NCT02516488?term=somashekar&rank=1
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest or financial ties to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Somashekar G Krishna, MD, MPH, Assistant Professor, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Telephone: +1-614-2936255 Fax: +1-614-2938518
Received: February 6, 2017
Peer-review started: February 8, 2017
First decision: March 3, 2017
Revised: March 21, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 14, 2017
Processing time: 98 Days and 5 Hours
Abstract
AIM

To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs).

METHODS

In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively.

RESULTS

A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a “fern pattern” of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology.

CONCLUSION

In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

Keywords: Confocal laser endomicroscopy; Serous cystadenoma; Pancreatic neuroendocrine tumor; Intraductal papillary mucinous neoplasm; Pancreatic cystic neoplasm

Core tip: We performed a prospective study to investigate the reproducibility of in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for pancreatic cystic lesions (PCLs). A total of 10 subjects underwent in vivo EUS-nCLE and subsequently ex vivo CLE of the PCL following surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. We found that characteristic in vivo nCLE patterns were observed during ex vivo pCLE of resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. These findings support the application of EUS-nCLE in the diagnosis of PCLs.