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Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions.

ABSTRACT: BACKGROUND AND AIM:The diagnosis and therapeutic management of large single pancreatic cystic lesions (PCLs) represent major issues for clinicians and essentially rely on endoscopic ultrasound fine-needle aspiration (EUS-FNA) findings. Needle-based confocal laser endomicroscopy (nCLE) has high diagnostic performance for PCLs. This study aimed to evaluate the impact of nCLE on the therapeutic management of patients with single PCLs. METHODS:Retrospective and comparative study. Five independent pancreatic disease experts from tertiary hospitals independently reviewed data from a prospective database of 206 patients with single PCL, larger than 2 cm and who underwent EUS-FNA and nCLE. Two evaluations were performed. The first one included the sequential review of clinical information, EUS report and FNA results. The second one included the same data?+?nCLE report. Participants had to propose a therapeutic management for each case. RESULTS:The addition of nCLE to EUS-FNA led to significant changes in therapeutic management for 28% of the patients (p?

SUBMITTER: Palazzo M

PROVIDER: S-EPMC7214514 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions.

Palazzo Maxime M Sauvanet Alain A Gincul Rodica R Borbath Ivan I Vanbiervliet Goeffroy G Bourdariat Raphaël R Lemaistre Anne-Isabelle AI Pujol Bertrand B Caillol Fabrice F Palazzo Laurent L Aubert Alain A Maire Frédérique F Buscail Louis L Giovannini Marc M Marque Sébastien S Napoléon Bertrand B

Surgical endoscopy 20190813 6

<h4>Background and aim</h4>The diagnosis and therapeutic management of large single pancreatic cystic lesions (PCLs) represent major issues for clinicians and essentially rely on endoscopic ultrasound fine-needle aspiration (EUS-FNA) findings. Needle-based confocal laser endomicroscopy (nCLE) has high diagnostic performance for PCLs. This study aimed to evaluate the impact of nCLE on the therapeutic management of patients with single PCLs.<h4>Methods</h4>Retrospective and comparative study. Five ...[more]

PMID: 31410626

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Project description:Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (EUS-nCLE) has been shown to aid in the diagnosis of cystic pancreatic lesions. This is a pilot project to study its findings in patients with solid pancreatic lesions (SPLs) with a prospective single-blinded study design.Patients with SPLs undergoing trans-gastric EUS fine needle aspiration (EUS-FNA) from July 2013 to March 2014 were prospectively enrolled. The nCLE diagnoses were compared with the final diagnoses. Researchers learned about the EUS-nCLE findings from previously published studies and applied it to diagnose SPLs. In the meantime, the findings were recorded.In total, 22 patients were recruited (mean age 62.7 years, SD 13.8 years; 14 men and eight women). The mean maximal tumor diameter was 36.0 mm (SD 10.9 mm). EUS-nCLE yielded satisfactory images in all patients during the first EUS procedure and diagnosed benign and malignant SPLs in 3 and 19 patients, respectively. Final diagnoses of malignant SPLs were made in 19 patients. Benign SPLs were eventually diagnosed in three patients, with confirmed the cytology and disease stability during the 12-month follow-up period. At the end of the project, based on the results of this current study, EUS-nCLE findings for malignant SPLs were dark clumping with or without dilated vessels (> 40 μm). There were two criteria for diagnosing benign lesions which were white fibrous bands and normal acini cells. The accuracy rate of EUS-nCLE was 90.9 % (20/22). One falsely diagnosed malignant SPL was an inflammatory mass from a recent acute pancreatitis. Another one with a pancreatic neuroendocrine tumor presenting with a symptomatic pseudocyst was incorrectly diagnosed as an inflammatory mass. This was likely from sampling error of the EUS-nCLE probe in an inflammatory area. Only one patient had post EUS-FNA bleeding but did not require a blood transfusion. The inter-observer agreement among three blinded endoscopists was almost perfect (Kappa 0.82).EUS-nCLE is a promising technique for the diagnosis of SPLs with good inter-observer agreement. Study registration‎: TCTR20140402001.

Dataset Information

Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions.

Publications

Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions.

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