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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).
- Source :
-
Gastrointestinal endoscopy [Gastrointest Endosc] 2017 Oct; Vol. 86 (4), pp. 644-654.e2. Date of Electronic Publication: 2017 Mar 10. - Publication Year :
- 2017
-
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.<br />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.<br />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.<br />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.).<br /> (Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Cystadenoma, Serous diagnostic imaging
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Humans
Intravital Microscopy
Male
Middle Aged
Needles
Neuroendocrine Tumors diagnostic imaging
Observer Variation
Pancreatic Cyst diagnostic imaging
Pancreatic Neoplasms diagnostic imaging
Retrospective Studies
Cystadenoma, Serous pathology
Endosonography methods
Microscopy, Confocal methods
Neuroendocrine Tumors pathology
Pancreatic Cyst pathology
Pancreatic Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6779
- Volume :
- 86
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Gastrointestinal endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 28286093
- Full Text :
- https://doi.org/10.1016/j.gie.2017.03.002