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Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration.
J Pathol Inform 2019; 10:34JP

Abstract

Background

Pancreatic cystic lesions are often challenging entities for diagnosis and management. EUS-FNA diagnostic accuracy is limited by paucicellularity of cytology specimens and sampling errors. Needle-based confocal laser endomicroscopy (nCLE) provides real-time imaging of the microscopic structure of the cystic lesion and could result in a more accurate diagnosis.

Aims and Objectives

To determine the diagnostic utility of in vivo nCLE and EUS-FNA in the diagnosis and histologic characterization of pancreatic cystic lesions (PCL).

Materials and Methods

All patients diagnosed with PCL who had undergone nCLE and FNA over a 10-year period within a major urban teaching hospital were included in this study. All gastroenterology reports of the nCLE images and corresponding pathologist findings from the EUS-FNA were collected and compared with, a final diagnosis prospectively collected from clinicopathological and imaging data.

Results

A total of n=32 patients were included in this study, which consisted of n=13 serous cystadenoma (SCA), n=7 intraductal papillary mucinous neoplasms (IPMN), n=2 mucinous cystic neoplasms (MCN), n=3 well-differentiated neuroendocrine tumors, n=2 cysts, n=2 benign pancreatic lesions, n=1 adenocarcinoma, n=1 gastrointestinal stromal tumor (GIST) and n=1 lymphangioma. The overall diagnostic rate was higher in nCLE (87.5%) vs. EUS-FNA (71.9%) While the diagnostic accuracy of nCLE and EUS-FNA were comparable in characterization of benign vs. malignant lesions, the nCLE diagnosis demonstrated higher accuracy rate in identifying mucinous cystic neoplasms compared to EUS-FNA.

Conclusion

nCLE is a useful companion diagnostic tool for pancreatic cystic lesions and could assist the cytopathologist to better triage the sample for required ancillary testing and treatment planning. The combination of nCLE and EUS-FNA may be especially helpful in reducing the proportion of cases categorized as non-diagnostic.

Authors+Show Affiliations

Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA.Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA.Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA.Department of Pathology, The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31799020

Citation

Haghighi, Mehrvash, et al. "Diagnosis of Pancreatic Cystic Lesions By Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy Versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration." Journal of Pathology Informatics, vol. 10, 2019, p. 34.
Haghighi M, Sethi A, Tavassoly I, et al. Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. J Pathol Inform. 2019;10:34.
Haghighi, M., Sethi, A., Tavassoly, I., Gonda, T. A., Poneros, J. M., & McBride, R. B. (2019). Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Journal of Pathology Informatics, 10, p. 34. doi:10.4103/jpi.jpi_32_19.
Haghighi M, et al. Diagnosis of Pancreatic Cystic Lesions By Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy Versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. J Pathol Inform. 2019;10:34. PubMed PMID: 31799020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. AU - Haghighi,Mehrvash, AU - Sethi,Amrita, AU - Tavassoly,Iman, AU - Gonda,Tamas A, AU - Poneros,John M, AU - McBride,Russell B, Y1 - 2019/11/13/ PY - 2019/05/26/received PY - 2019/09/19/accepted PY - 2019/12/5/entrez KW - Advanced imaging technique KW - confocal laser endomicroscopy KW - pancreatic cystic lesion KW - probe-based confocal laser endomicroscopy SP - 34 EP - 34 JF - Journal of pathology informatics JO - J Pathol Inform VL - 10 N2 - Background: Pancreatic cystic lesions are often challenging entities for diagnosis and management. EUS-FNA diagnostic accuracy is limited by paucicellularity of cytology specimens and sampling errors. Needle-based confocal laser endomicroscopy (nCLE) provides real-time imaging of the microscopic structure of the cystic lesion and could result in a more accurate diagnosis. Aims and Objectives: To determine the diagnostic utility of in vivo nCLE and EUS-FNA in the diagnosis and histologic characterization of pancreatic cystic lesions (PCL). Materials and Methods: All patients diagnosed with PCL who had undergone nCLE and FNA over a 10-year period within a major urban teaching hospital were included in this study. All gastroenterology reports of the nCLE images and corresponding pathologist findings from the EUS-FNA were collected and compared with, a final diagnosis prospectively collected from clinicopathological and imaging data. Results: A total of n=32 patients were included in this study, which consisted of n=13 serous cystadenoma (SCA), n=7 intraductal papillary mucinous neoplasms (IPMN), n=2 mucinous cystic neoplasms (MCN), n=3 well-differentiated neuroendocrine tumors, n=2 cysts, n=2 benign pancreatic lesions, n=1 adenocarcinoma, n=1 gastrointestinal stromal tumor (GIST) and n=1 lymphangioma. The overall diagnostic rate was higher in nCLE (87.5%) vs. EUS-FNA (71.9%) While the diagnostic accuracy of nCLE and EUS-FNA were comparable in characterization of benign vs. malignant lesions, the nCLE diagnosis demonstrated higher accuracy rate in identifying mucinous cystic neoplasms compared to EUS-FNA. Conclusion: nCLE is a useful companion diagnostic tool for pancreatic cystic lesions and could assist the cytopathologist to better triage the sample for required ancillary testing and treatment planning. The combination of nCLE and EUS-FNA may be especially helpful in reducing the proportion of cases categorized as non-diagnostic. SN - 2229-5089 UR - https://www.unboundmedicine.com/medline/citation/31799020/Diagnosis_of_Pancreatic_Cystic_Lesions_by_Virtual_Slicing:_Comparison_of_Diagnostic_Potential_of_Needle-Based_Confocal_Laser_Endomicroscopy_versus_Endoscopic_Ultrasound-Guided_Fine-Needle_Aspiration DB - PRIME DP - Unbound Medicine ER -