Retrospective Cohort Study
Copyright ©The Author(s) 2022.
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 129-141
Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.129
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 process3 (2.3)3 (5.6)
Head46 (35.7)17 (36.2)9 (32.1)20 (37.0)
Neck 13 (10.1)3 (6.4)4 (14.3)6 (11.1)
Body36 (27.9)14 (29.8)8 (28.6)14 (25.9)
Tail31 (24.0)13 (27.7)7 (25.20)11 (20.4)
Cyst size (mm), n (%)
< 10 mm33 (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-EUS20 (15.5)11 (39.3)9 (16.7)
Cystoscopy27 (20.9)1 (3.6)26 (48.1)
mFB 36 (27.9)36 (66.7)
nCLE44 (34.1)44 (81.5)
Pancreatic cyst diagnosis, n (%)< 0.001b
Malignant281 (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 cystadenoma4 (3.1)1 (3.6)3 (5.6)
Intraductal papillary mucinous neoplasm70 (54.3)45 (95.7)14 (50.0)11 (20.4)
Neuroendocrine 1 (0.8)1 (1.9)
Non-malignant248 (37.2)1 (2.1)9 (32.1)38 (70.4)
Serous cystadenoma46 (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.
Table 2 Association between different additional performed techniques vs a positive observed agreement for malignancy diagnosis among endoscopic ultrasound and endoscopic ultrasound-related techniques vs 24-mo follow-up [OR (95%CI; P value)]
Univariate analysis1
Multivariate analysis1
EUS alone (n = 47)0.066 (0.025-0.157; < 0.001)
EUS-FNA (n = 21)2.409 (0.905-7.182; 0.091)
CE-EUS (n = 20)1.694 (0.642-4.811; 0.298)
Cystoscopy (n = 27)4.950 (1.862-15.695; 0.003)0.622 (0.125-2.813; 0.541)
mFB (n = 36)6.625 (2.667-19.024; < 0.001)3.425 (1.104-11.682; 0.038)
nCLE (n = 44)10.489 (4.242-30.125; < 0.001)8.441 (2.698-33.081; < 0.001)
1Positive observed agreement: In 70/129 (54.3%) there was a positive agreement between endoscopic ultrasound vs 24-mo follow-up for a malignant and non-malignant diagnosis.
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.
Table 3 Overall diagnostic accuracy for determining malignancy [% (95%CI)]
EUS alone (n = 47)
EUS + FNA/CE/ Cystoscopy (n = 28)
EUS + mFB (n = 36)
EUS + nCLE (n = 44)
EUS + nCLE + mFB (n = 26)
Sensitivity 7/7; 100.0% (59.3-100.0)10/11; 90.9% (58.7-99.8)7/8; 87.5% (47.3-99.7)8/9; 88.8%; (51.8-99.7)7/7; 100.0% (59.0-100.0)
Specificity 1/40; 2.5% (0.1-13.2)8/17; 47.1% (22.9-72.3)23/28; 82.1% (63.1-93.9)30/35; 85.7% (69.7-95.2)17/19; 89.4% (66.9-98.7)
PPV7/46; 15.2% (6.3-28.9)10/19; 52.6% (28.9-75.6)7/12; 58.3% (27.7-84.8)8/13; 61.5% (31.6-86.1)7/9; 77.8% (40.0-97.1)
NPV1/1; 100.0% (2.5-100.0)8/9; 88.9% (51.8-99.7)23/24; 95.8% (78.9-99.8)30/31; 97% (83-100)17/17; 100.0% (80.5-100.0)
PLR1.03 (0.98-1.08)1.72 (1.06-2.79)4.90 (2.12-11.31)6.22 (2.68-14.47)9.50 (2.56-35.24)
NLRn/a0.19 (0.03-1.34)0.15 (0.02-0.96)0.13 (0.02-0.83)n/a
Observed agreement 8/47 (17%); P = 0.672a18/28 (64.3%); P = 0.049a30/36 (83.3%); P < 0.001a38/44 (86.4%); P < 0.001a24/26 (92.3%); P < 0.001a
MCC+ 0.06+ 0.40+ 0.61+ 0.66+ 0.83
AU-ROC 51.3%; P = 0.359b69.0%; P = 0.02b84.8%; P < 0.001b87.3%; P < 0.001b94.7%; P < 0.001b
aFisher's exact test for count data.
bMann–Whitney U test.
EUS: Endoscopic ultrasound; nCLE: Confocal laser endomicroscopy; mFB: Endoscopic ultrasound-guided through-the-needle direct intracystic micro forceps biopsy; PPV: Positive predictive value; NPV: Negative predictive value; PLR: Positive likelihood ratio; NLR: Negative likelihood ratio; MCC: Matthews correlation coefficient; AU-ROC: Area under the receiver operating characteristics curve; n/a: Not available.
  • Citation: Robles-Medranda C, Olmos JI, Puga-Tejada M, Oleas R, Baquerizo-Burgos J, Arevalo-Mora M, Del Valle Zavala R, Nebel JA, Calle Loffredo D, Pitanga-Lukashok H. 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. World J Gastrointest Endosc 2022; 14(3): 129-141
  • URL: https://www.wjgnet.com/1948-5190/full/v14/i3/129.htm
  • DOI: https://dx.doi.org/10.4253/wjge.v14.i3.129