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In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study.
World J Gastroenterol 2017; 23(18):3338-3348WJ

Abstract

AIM

To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs).

METHODS

In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively.

RESULTS

A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology.

CONCLUSION

In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

Authors+Show Affiliations

Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

28566895

Citation

Krishna, Somashekar G., et al. "In Vivo and Ex Vivo Confocal Endomicroscopy of Pancreatic Cystic Lesions: a Prospective Study." World Journal of Gastroenterology, vol. 23, no. 18, 2017, pp. 3338-3348.
Krishna SG, Modi RM, Kamboj AK, et al. In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study. World J Gastroenterol. 2017;23(18):3338-3348.
Krishna, S. G., Modi, R. M., Kamboj, A. K., Swanson, B. J., Hart, P. A., Dillhoff, M. E., ... Conwell, D. L. (2017). In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study. World Journal of Gastroenterology, 23(18), pp. 3338-3348. doi:10.3748/wjg.v23.i18.3338.
Krishna SG, et al. In Vivo and Ex Vivo Confocal Endomicroscopy of Pancreatic Cystic Lesions: a Prospective Study. World J Gastroenterol. 2017 May 14;23(18):3338-3348. PubMed PMID: 28566895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study. AU - Krishna,Somashekar G, AU - Modi,Rohan M, AU - Kamboj,Amrit K, AU - Swanson,Benjamin J, AU - Hart,Phil A, AU - Dillhoff,Mary E, AU - Manilchuk,Andrei, AU - Schmidt,Carl R, AU - Conwell,Darwin L, PY - 2017/02/06/received PY - 2017/03/21/revised PY - 2017/04/12/accepted PY - 2017/6/2/entrez PY - 2017/6/2/pubmed PY - 2018/4/17/medline KW - Confocal laser endomicroscopy KW - Intraductal papillary mucinous neoplasm KW - Pancreatic cystic neoplasm KW - Pancreatic neuroendocrine tumor KW - Serous cystadenoma SP - 3338 EP - 3348 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 23 IS - 18 N2 - AIM: To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). METHODS: In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS: A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. CONCLUSION: In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/28566895/In_vivo_and_ex_vivo_confocal_endomicroscopy_of_pancreatic_cystic_lesions:_A_prospective_study_ L2 - http://www.wjgnet.com/1007-9327/full/v23/i18/3338.htm DB - PRIME DP - Unbound Medicine ER -