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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions
Helga Bertani, Raffaele Pezzilli, Flavia Pigò, Mauro Bruno, Claudio De Angelis, Guido Manfredi, Gabriele Delconte, Rita Conigliaro, Elisabetta Buscarini
Helga Bertani, Flavia Pigò, Rita Conigliaro, Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41124, Italy
Raffaele Pezzilli, Department of Internal Medicine, Policlinico S.Orsola Malpighi, Bologna 40121, Italy
Mauro Bruno, Claudio De Angelis, Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, Turin 10100, Italy
Guido Manfredi, Elisabetta Buscarini, Gastroenterology and Digestive Endoscopy Department, Ospedale Maggiore, Crema 26013, Italy
Gabriele Delconte, Department of Diagnostic Endoscopy and Endoscopic Surgery, Istituto Nazionale Tumori, Milano 20019, Italy
Author contributions: Bertani H and Buscarini E conceived the study; Pezzilli R and Pigò F conducted the statistical analyses; Bertani H and Pigò F drafted the manuscript; Bruno M, De Angelis C, Manfredi G and Delconte G collected the data; Conigliaro R and Buscarini E reviewed the manuscript.
Institutional review board statement: The study was carried out in accordance with the Declaration of Helsinki and was approved by Ethical Committee of Baggiovara Hospital in Modena (Prot. 16/11/2015 prat n 4327).
Informed consent statement: All patients received written information about the study with results and possible complications. They all provide informed consent, as a negation of a written informed consent resulted in exclusion of the patient from the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The dataset is available. For more information please contact Pigo.flavia@aou.mo.it. We can provide the anonymized version.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/ Corresponding author: Helga Bertani, MD, Academic Research, Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Via del Pozzo 71, Modena 41124, Italy. bertani.helga@aou.mo.it
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: June 17, 2021
Revised: June 25, 2021
Accepted: September 6, 2021
Article in press: September 6, 2021
Published online: November 16, 2021
BACKGROUND
Pancreatic cystic lesions (PCLs) are considered a precursor of pancreatic cancer. Needle-based confocal endomicroscopy (nCLE) is an imaging technique that enables visualization of the mucosal layer to a micron resolution. Its application has demonstrated promising results in the distinction of PCLs. This study evaluated the utility of nCLE in patients with indeterminate PCLs undergoing endoscopic ultrasound fine-needle aspiration (EUS-FNA) to distinguish mucinous from non-mucinous lesions.
AIM
To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous lesions.
METHODS
Patients who required EUS-FNA between 2015 and 2017 were enrolled prospectively. During EUS-FNA, confocal imaging, analyses of the tumor markers carcinoembryonic antigen and amylase, and cytologic examination were conducted. All patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance imaging. nCLE videos were independently reviewed by 6 observers to reach a final diagnosis (mucinous vs non-mucinous) based on criteria derived from previous studies; if there was disagreement > 20%, a final diagnosis was discussed after consensus re-evaluation. The sensitivity, specificity, and accuracy of nCLE were calculated. Adverse events were recorded.
RESULTS
Fifty-nine patients were included in this study. Final diagnoses were derived from surgery in 10 patients, cytology in 13, and imaging and multidisciplinary team review in 36. Three patients were excluded from final diagnosis due to problems with nCLE acquisition. Fifty-six patients were included in the final analysis. The sensitivity, specificity, and accuracy of nCLE were 80% [95% confidence interval (CI): 65-90], 100% (95%CI: 72-100), and 84% (95%CI: 72-93), respectively. Post-procedure acute pancreatitis occurred in 5%.
CONCLUSION
EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.
Core Tip: Pancreatic cystic lesions are considered a precursor of pancreatic cancer. Needle-based confocal endomicroscopy is an imaging technique that enables visualization of the mucosal layer to a micron resolution. Endoscopic ultrasound with fine-needle aspiration is the most accurate procedure for identifying pancreatic cystic lesions, as it combines cytology with analysis of intracystic carcinoembryonic antigen level, although its accuracy is low. Needle-based confocal endomicroscopy has demonstrated promising results.
