Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 129-141
Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.129
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
Carlos Robles-Medranda, Juan I Olmos, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Martha Arevalo-Mora, Raquel Del Valle Zavala, Joao Autran Nebel, Daniel Calle Loffredo, Hannah Pitanga-Lukashok
Carlos Robles-Medranda, Juan I Olmos, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Martha Arevalo-Mora, Raquel Del Valle Zavala, Joao Autran Nebel, Daniel Calle Loffredo, Hannah Pitanga-Lukashok, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil 090505, Ecuador
Author contributions: Robles-Medranda C contributed to study conception, design, drafting; Olmos JI, Del Valle Zavala R, Nebel JA, Calle Loffredo D and Pitanga-Lukashok H contributed to study design, acquisition of data; Puga-Tejada M and Oleas R contributed to study design; Baquerizo-Burgos J, Puga-Tejada M and Oleas R contributed to study drafting, acquisition/analysis of data; Arevalo-Mora M did final database study consolidation and encryption, data acquisition; Robles-Medranda C, Olmos JI, Del Valle Zavala R, Nebel JA, Calle Loffredo D, Pitanga-Lukashok H, Puga-Tejada M, Oleas R and Arevalo-Mora M contributed to critical revision of important intellectual content; all authors did final approval of the version to be published.
Institutional review board statement: The study was approved by the Institutional Review Board of Instituto Ecuatoriano de Enfermedades Digestivas.
Informed consent statement: All study participants, and their legal guardians, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: Robles-Medranda C reports other from Pentax Medical, other from Boston Scientific, other from Steris, other from Medtronic, other from Motus, other from Micro-tech, other from G-Tech Medical Supply, other from CREO Medical, other from Mdconsgroup, outside the submitted work; The other authors declare no conflicts of interest.
Data sharing statement: The data that support the findings of this study are openly available by contacting the corresponding author.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos Robles-Medranda, FASGE, MD, Chief Doctor, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel Romero Castillo y Av. Juan Tanca Marengo, Torre Vitalis, Mezanine 3, Guayaquil 090505, Ecuador. carlosoakm@yahoo.es
Received: July 27, 2021
Peer-review started: July 27, 2021
First decision: November 11, 2021
Revised: December 15, 2021
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: March 16, 2022
Abstract
BACKGROUND

Currently, there is insufficient data about the accuracy in the diagnosing of pancreatic cystic lesions (PCLs), especially with novel endoscopic techniques such as with direct intracystic micro-forceps biopsy (mFB) and needle-based confocal laser-endomicroscopy (nCLE).

AIM

To compare the accuracy of endoscopic ultrasound (EUS) and associated techniques for the detection of potentially malignant PCLs: EUS-guided fine needle aspiration (EUS-FNA), contrast-enhanced EUS (CE-EUS), EUS-guided fiberoptic probe cystoscopy (cystoscopy), mFB, and nCLE.

METHODS

This was a single-center, retrospective study. We identified patients who had undergone EUS, with or without additional diagnostic techniques, and had been diagnosed with PCLs. We determined agreement among malignancy after 24-mo follow-up findings with detection of potentially malignant PCLs via the EUS-guided techniques and/or EUS-guided biopsy when available (EUS malignancy detection).

RESULTS

A total of 129 patients were included, with EUS performed alone in 47/129. In 82/129 patients, EUS procedures were performed with additional EUS-FNA (21/82), CE-EUS (20/82), cystoscopy (27/82), mFB (36/82), nCLE (44/82). Agreement between EUS malignancy detection and the 24-mo follow-up findings was higher when associated with additional diagnostic techniques than EUS alone [62/82 (75.6%) vs 8/47 (17%); OR 4.35, 95%CI: 2.70-7.37; P < 0.001]. The highest malignancy detection accuracy was reached when nCLE and direct intracystic mFB were both performed, with a sensitivity, specificity, positive predictive value, negative predictive value and observed agreement of 100%, 89.4%, 77.8%, 100% and 92.3%, respectively (P < 0.001 compared with EUS-alone).

CONCLUSION

The combined use of EUS-guided mFB and nCLE improves detection of potentially malignant PCLs compared with EUS-alone, EUS-FNA, CE-EUS or cystoscopy.

Keywords: Pancreatic cysts, Endoscopic ultrasound-guided fine-needle aspiration, Confocal microscopy, Image-guided biopsy

Core Tip: This retrospective study compared the accuracy of endoscopic ultrasound (EUS) and associated techniques such as EUS-guided fine needle aspiration (EUS-FNA), contrast-enhanced EUS (CE-EUS), EUS-guided fiberoptic probe cystoscopy (cystoscopy), EUS-guided direct intracystic micro-forceps biopsy (mFB), and EUS-guided needle-based confocal laser-endomicroscopy (nCLE) for the detection of potentially malignant pancreatic cystic lesions (PCLs) in 129 patients. Patients were allocated to three cohorts: those evaluated via EUS alone; via EUS-FNA, CE-EUS and/or cystoscopy; and with mFB plus nCLE. We observed that combining EUS, mFB, and nCLE had a statistically significant improved detection of potentially malignant PCLs compared to any of the evaluated techniques alone.