EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video)
| Autor: | John M. DeWitt, Megan Q. Chan, Jon P. Walker, Peter P. Stanich, Sebastian Strobel, Bertrand Napoleon, Mohamed O. Othman, Samer El-Dika, Anjuli K. Luthra, Alecia Blaszczak, Sean T. McCarthy, Christina A. Arnold, Dana Lee, Pradermchai Kongkam, Damien Meng Yew Tan, Anand Patel, Darwin L. Conwell, Somashekar G. Krishna, Kyle Porter, Christopher J. DiMaio, Phil A. Hart |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Pancreatic Intraductal Neoplasms Endosonography 03 medical and health sciences 0302 clinical medicine Cytology medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Endoscopic Ultrasound-Guided Fine Needle Aspiration Aged Microscopy Confocal Intraductal papillary mucinous neoplasm Receiver operating characteristic business.industry Lasers Gastroenterology Middle Aged medicine.disease digestive system diseases Confidence interval Pancreatic Neoplasms Dysplasia 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Histopathology Female Pancreatic cysts business Nuclear medicine |
| Zdroj: | Gastrointestinal endoscopy. 91(3) |
| ISSN: | 1097-6779 |
| Popis: | Background and Aims Previous studies have validated EUS-guided needle-based confocal laser endomicroscopy (nCLE) diagnosis of intraductal papillary mucinous neoplasms (IPMNs). We sought to derive EUS-guided nCLE criteria for differentiating IPMNs with high-grade dysplasia/adenocarcinoma (HGD-Ca) from those with low/intermediate-grade dysplasia (LGD). Methods We performed a post hoc analysis of consecutive IPMNs with a definitive diagnosis from a prospective study evaluating EUS-guided nCLE in the diagnosis of pancreatic cysts. Three internal endosonographers reviewed all nCLE videos for the patients and identified potential discriminatory EUS-guided nCLE variables to differentiate HGD-Ca from LGD IPMNs (phase 1). Next, an interobserver agreement (IOA) analysis of variables from phase 1 was performed among 6 blinded external nCLE experts (phase 2). Last, 7 blinded nCLE-naive observers underwent training and quantified variables with the highest IOA from phase 2 using dedicated software (phase 3). Results Among 26 IPMNs (HGD-Ca in 16), the reference standard was surgical histopathology in 24 and cytology confirmation of metastatic liver lesions in 2 patients. EUS-guided nCLE characteristics of increased papillary epithelial “width” and “darkness” were the most sensitive variables (90%; 95% confidence interval [CI], 84%-94% and 91%; 95% CI, 85%-95%, respectively) and accurate (85%; 95% CI, 78%-90% and 84%; 95% CI, 77%-89%, respectively) with substantial (κ = 0.61; 95% CI, 0.51-0.71) and moderate (κ = 0.55; 95% CI, 0.45-0.65) IOAs for detecting HGD-Ca, respectively (phase 2). Logistic regression models were fit for the outcome of HGD-Ca as predictor variables (phase 3). For papillary width (cut-off ≥50 μm), the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for detection of HGD-Ca were 87.5% (95% CI, 62%-99%), 100% (95% CI, 69%-100%), and 0.95, respectively. For papillary darkness (cut-off ≤90 pixel intensity), the sensitivity, specificity, and AUC for detection of HGD-Ca were 87.5% (95% CI, 62%-99%), 100% (95% CI, 69%-100%), and 0.90, respectively. Conclusions In this derivation study, quantification of papillary epithelial width and darkness identified HGD-Ca in IPMNs with high accuracy. These quantifiable variables can be used in multicenter studies for risk stratification of IPMNs. (Clinical trial registration number: NCT02516488.) |
| Databáze: | OpenAIRE |
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