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Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos).
Gastrointest Endosc 2017; 86(4):644-654.e2GE

Abstract

BACKGROUND AND AIMS

EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis.

METHODS

Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used.

RESULTS

A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively.

CONCLUSIONS

EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.).

Authors+Show Affiliations

Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.Division of Gastroenterology, Department of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA.Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.Department of Gastroenterology, Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Lyon, France.Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador.Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Pub Type(s)

Journal Article
Video-Audio Media

Language

eng

PubMed ID

28286093

Citation

Krishna, Somashekar G., et al. "Needle-based Confocal Laser Endomicroscopy for the Diagnosis of Pancreatic Cystic Lesions: an International External Interobserver and Intraobserver Study (with Videos)." Gastrointestinal Endoscopy, vol. 86, no. 4, 2017, pp. 644-654.e2.
Krishna SG, Brugge WR, Dewitt JM, et al. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointest Endosc. 2017;86(4):644-654.e2.
Krishna, S. G., Brugge, W. R., Dewitt, J. M., Kongkam, P., Napoleon, B., Robles-Medranda, C., ... Conwell, D. L. (2017). Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointestinal Endoscopy, 86(4), pp. 644-654.e2. doi:10.1016/j.gie.2017.03.002.
Krishna SG, et al. Needle-based Confocal Laser Endomicroscopy for the Diagnosis of Pancreatic Cystic Lesions: an International External Interobserver and Intraobserver Study (with Videos). Gastrointest Endosc. 2017;86(4):644-654.e2. PubMed PMID: 28286093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). AU - Krishna,Somashekar G, AU - Brugge,William R, AU - Dewitt,John M, AU - Kongkam,Pradermchai, AU - Napoleon,Bertrand, AU - Robles-Medranda,Carlos, AU - Tan,Damien, AU - El-Dika,Samer, AU - McCarthy,Sean, AU - Walker,Jon, AU - Dillhoff,Mary E, AU - Manilchuk,Andrei, AU - Schmidt,Carl, AU - Swanson,Benjamin, AU - Shah,Zarine K, AU - Hart,Phil A, AU - Conwell,Darwin L, Y1 - 2017/03/10/ PY - 2016/11/21/received PY - 2017/03/01/accepted PY - 2017/3/14/pubmed PY - 2018/5/31/medline PY - 2017/3/14/entrez SP - 644 EP - 654.e2 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 86 IS - 4 N2 - BACKGROUND AND AIMS: EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. METHODS: Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. RESULTS: A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively. CONCLUSIONS: EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.). SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/28286093/Needle_based_confocal_laser_endomicroscopy_for_the_diagnosis_of_pancreatic_cystic_lesions:_an_international_external_interobserver_and_intraobserver_study__with_videos__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(17)30179-7 DB - PRIME DP - Unbound Medicine ER -