and confocal endomicroscopy of pancreatic cystic lesions: A prospective study.

AIM

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).

METHODS

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.

RESULTS

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.

CONCLUSION

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.