Krishna Somashekar G, Modi Rohan M, Kamboj Amrit K, Swanson Benjamin J, Hart Phil A, Dillhoff Mary E, Manilchuk Andrei, Schmidt Carl R, Conwell Darwin L
Somashekar G Krishna, Phil A Hart, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
World J Gastroenterol. 2017 May 14;23(18):3338-3348. doi: 10.3748/wjg.v23.i18.3338.
To investigate the reproducibility of the endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs).
In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for and CLE imaging respectively.
A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during pCLE imaging of the surgically resected PCLs. Both and CLE imaging findings correlated with surgical histopathology.
nCLE patterns are reproducible in pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.
在一项研究中调查内镜超声（EUS）引导下基于针的共聚焦内镜显微镜检查（nCLE）图像模式的可重复性，并将其与手术组织病理学进行比较，以对胰腺囊性病变（PCL）进行特征性描述。
在一项评估EUS-nCLE用于PCL评估的前瞻性研究中，10名受试者在EUS期间接受了nCLE检查（AQ-Flex nCLE微型探头；Cellvizio，莫纳克亚山，法国巴黎），并在手术切除后对PCL进行了基于探头的共聚焦内镜检查（pCLE）（Gastroflex超高清探头，Cellvizio）。从CLE成像区域获取活检组织进行比较组织病理学检查。所有受试者在EUS和胰腺手术前分别接受静脉注射荧光素用于nCLE和pCLE成像。
共纳入10名受试者（平均年龄53±12岁；5名女性），PCL平均大小为34.8±14.3mm。手术组织病理学证实有2例导管内乳头状黏液性肿瘤（IPMN）、3例黏液性囊性肿瘤（MCN）、2例囊性神经内分泌肿瘤（囊性-NET）、1例浆液性囊腺瘤（SCA）和2例鳞状上皮内衬的PCL。特征性nCLE图像模式包括IPMN的乳头状突起、MCN的水平型上皮带、囊性-NET的细胞巢和小梁，以及SCA的“蕨类图案”血管。在手术切除的PCL的pCLE成像中观察到相同的图像模式。nCLE和pCLE成像结果均与手术组织病理学相关。
nCLE模式在手术切除的PCL的pCLE中对于所有主要的肿瘤性PCL都是可重复的。这些发现进一步支持了EUS-nCLE作为PCL诊断中的一种成像生物标志物的应用。
