Napoleon Bertrand, Lemaistre Anne-Isabelle, Pujol Bertrand, Caillol Fabrice, Lucidarme Damien, Bourdariat Raphaël, Morellon-Mialhe Blandine, Fumex Fabien, Lefort Christine, Lepilliez Vincent, Palazzo Laurent, Monges Geneviève, Poizat Flora, Giovannini Marc
Department of Gastroenterology, Hôpital Privé Jean Mermoz, Générale de Santé, 4 rue Jacqueline Auriol, 69008, Lyon, France.
Department of Biopathology, Centre Léon Bérard, Lyon, France.
Surg Endosc. 2016 Jun;30(6):2603-12. doi: 10.1007/s00464-015-4510-5. Epub 2015 Oct 1.
The differential diagnosis of solitary pancreatic cystic lesions is sometimes difficult. Needle-based confocal laser endomicroscopy (nCLE) performed during endoscopic ultrasound-fine-needle aspiration (EUS-FNA) enables real-time imaging of the internal structure of such cysts. Criteria have already been described for serous cystadenoma and intraductal papillary mucinous neoplasm (IPMN). The aims of the study were to determine new nCLE criteria for the diagnosis of pancreatic cystic lesions, to propose a comprehensive nCLE classification for the characterization of those lesions, and to carry out a first external retrospective validation .
Thirty-three patients with a lone pancreatic cystic lesion were included (CONTACT 1 study). EUS-FNA was combined with nCLE. Diagnosis was based on either pathology result (Group 1, n = 20) or an adjudication committee consensus (Group 2, n = 13). Six investigators, unblinded, studied cases from Group 1 and identified nCLE criteria for mucinous cystic neoplasm (MCN), pseudocyst (PC), and cystic neuroendocrine neoplasm (NEN). Four external reviewers assessed, blinded, the yield and interobserver agreement for the newly identified (MCN, PC) and previously described (IPMN, SC) criteria in a subset of 31 cases.
New nCLE criteria were described for MCN (thick gray line), PC (field of bright particles), and cystic NEN (black neoplastic cells clusters with white fibrous areas). These criteria correlated with the histological features of the corresponding lesions. In the retrospective validation, a conclusive nCLE result was obtained for 74 % of the cases (87 % "true" and 13 % "false" with respect to the final diagnosis). On this limited case series, the nCLE criteria showed a trend for high diagnostic specificity (>90 % for mucinous cysts, 100 % for non-mucinous cysts).
Based on this newly completed atlas of interpretation criteria, nCLE could facilitate the diagnosis of pancreatic cystic lesion types.
孤立性胰腺囊性病变的鉴别诊断有时颇具难度。在内镜超声引导下细针穿刺活检（EUS-FNA）过程中进行的基于针的共聚焦激光内镜检查（nCLE），能够对这类囊肿的内部结构进行实时成像。浆液性囊腺瘤和导管内乳头状黏液性肿瘤（IPMN）的诊断标准已有所描述。本研究的目的是确定胰腺囊性病变诊断的新nCLE标准，为这些病变的特征描述提出全面的nCLE分类，并进行首次外部回顾性验证。
纳入33例孤立性胰腺囊性病变患者（CONTACT 1研究）。EUS-FNA与nCLE相结合。诊断基于病理结果（第1组，n = 20）或裁决委员会的共识（第2组，n = 13）。6名未设盲的研究者研究第1组的病例，并确定黏液性囊性肿瘤（MCN）、假性囊肿（PC）和囊性神经内分泌肿瘤（NEN）的nCLE标准。4名外部评审人员在31例病例的子集中，设盲评估新确定的（MCN、PC）和先前描述的（IPMN、SC）标准的诊断率和观察者间一致性。
描述了MCN（粗灰线）、PC（亮颗粒区域）和囊性NEN（黑色肿瘤细胞簇伴白色纤维区域）的新nCLE标准。这些标准与相应病变的组织学特征相关。在回顾性验证中，74%的病例获得了确定性的nCLE结果（相对于最终诊断，87%为“真”，13%为“假”）。在这个有限的病例系列中，nCLE标准显示出高诊断特异性的趋势（黏液性囊肿>90%，非黏液性囊肿100%）。
基于这本新完成的解读标准图谱，nCLE有助于胰腺囊性病变类型的诊断。
