Endoscopy 2020; 52(S 01): S56
DOI: 10.1055/s-0040-1704174
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 Pancreatic cystic lesions Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

ACCURACY OF NEEDLE-BASED CONFOCAL LASER ENDOMICROSCOPY (NCLE) IN THE DISCRIMINATION OF MUCINOUS VS NON MUCINOUS PANCREATIC CYSTIC LESIONS: AN ITALIAN MULTICENTER PROSPECTIVE STUDY

H Bertani
1   Endoscopia Digestiva - Azienda Ospedaliera Universitaria - Baggiovara e Policlinico, Modena, Italy,
,
R Pezzilli
2   Azienda Ospealiera di Bologna, Pancreatic Unit, Bologna, Italy
,
F Pigò
1   Endoscopia Digestiva - Azienda Ospedaliera Universitaria - Baggiovara e Policlinico, Modena, Italy,
,
M Bruno
3   A.O.U. Citta della Salute e della Scienza di Torino, Endoscopia Digestiva e Servizio di Ecoendoscopia, Torino, Italy
,
CD Angelis
3   A.O.U. Citta della Salute e della Scienza di Torino, Endoscopia Digestiva e Servizio di Ecoendoscopia, Torino, Italy
,
G Manfredi
4   ASST Crema, Gastroenterologia ed Endoscopia Digestiva, Crema, Italy
,
G Delconte
5   Fondazione IRCCS Istituto Nazionale Dei Tumori, Endoscopia Diagnostica e Chirurgia Endoscopica, Milano, Italy
,
R Conigliaro
6   Azienda Ospedaliera Universitaria - Baggiovara e Policlinico, Endoscopia Digestiva, Modena, Italy
,
E Buscarini
4   ASST Crema, Gastroenterologia ed Endoscopia Digestiva, Crema, Italy
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Publikationsdatum:
23. April 2020 (online)

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Aims Pancreatic cystic lesions (PCLs) are considered a precursor of pancreatic cancer as some of them may carry malignant potential.

Confocal laser endomicroscopy is an innovative technique able to visualize to a micron resolution the mucosal layer, during endoscopic procedure. Its luminal application demonstrated excellent results in the distinction of neoplastic vs benign tissue. Limited data from 3 clinical trials are available about the accuracy of the technique. This study evaluated the accuracy of nCLE in patients with indeterminate PCL undergoing EUS-FNA to distinguish mucinous from non mucinous lesions.

Methods The study prospectively recruited patients who required EUS-FNA between January 2015 and December 2017 in four referral centers. All patients were followed up for at least 12 months with lab test and CT scan or MRI.

nCLE videos were independently reviewed from 6 observers to achieve an NCLE final diagnosis (mucinous vs non mucinous) based on criteria derived from previous studies; in case of disagreement >20% a final diagnosis was discussed after a consensus re-evaluation. Sensibility, specificity and accuracy of nCLE were calculated.

Results 59 patients were enrolled in the study, 18 male, 41 female. Final diagnosis were derived from histopathological analysis where available (10 surgery, 2 cytology from FNA, 47 based on imaging and multidisciplinary team review). 3 patients were excluded from final diagnosis due to technical problems in imaging acquisition.

56 were included in the final analysis. Sens. spec. accuracy of nCLE were 80% (95%CI 65-90), 100% (95 %CI 72-100) and 84% (95%CI 72-93) respectively. 6 (10%) adverse events occurred: 3 acute pancreatitis but none of them evolved to necrotizing pancreatitis; 2 intracystic self-limiting bleeding and 1 cyst infection.

Conclusions EUS-nCLE provides excellent performance rates compared to standard EUS-FNA for diagnosing indeterminate PCL