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Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

World Journal of Gastrointestinal Endoscopy 2021年第11期13卷 555-564页

作者： Helga Bertani Raffaele Pezzilli Flavia Pigo Mauro Bruno Claudio De Angelis Guido Manfredi gabriele delconte Rita Conigliaro Elisabetta Buscarini Gastroenterology and Digestive Endoscopy Unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41124Italy Department of Internal Medicine Policlinico S.Orsola MalpighiBologna 40121Italy Gastroenterology and Digestive Endoscopy Unit AOU Cittàdella Salute e della ScienzaUniversity of TurinTurin 10100Italy Gastroenterology and Digestive Endoscopy Department Ospedale MaggioreCrema 26013Italy Department of Diagnostic Endoscopy and Endoscopic Surgery Istituto Nazionale TumoriMilano 20019Italy

BACKGROUND Pancreatic cystic lesions(PCLs)are considered a precursor of pancreatic ***-based confocal endomicroscopy(nCLE)is an imaging technique that enables visualization of the mucosal layer to a micron *** application has demonstrated promising results in the distinction of *** 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 *** To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous *** Patients who required EUS-FNA between 2015 and 2017 were enrolled *** EUS-FNA,confocal imaging,analyses of the tumor markers carcinoembryonic antigen and amylase,and cytologic examination were *** patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance *** 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 *** sensitivity,specificity,and accuracy of nCLE were *** events were *** Fifty-nine patients were included in this *** diagnoses were derived from surgery in 10 patients,cytology in 13,and imaging and multidisciplinary team review in *** patients were excluded from final diagnosis due to problems with nCLE ***-six patients were included in the final *** 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),*** acute pancreatitis occurred in 5%.CONCLUSION EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.

关键词： Needle-based confocal endomicroscopy Pancreatic cystic lesion Pancreatic adenocarcinoma Endoscopic ultrasound Endoscopic ultrasound fine-needle aspiration Intraductal papillary mucinous neoplasm Serous cyst adenoma

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