Hao Sijie, Ding Weiqun, Jin Yuqin, Di Yang, Yang Feng, He Hang, Li Hengchao, Jin Chen, Fu Deliang, Zhong Liang
Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
Gastroenterology and Endoscopy, Huashan Hospital, Fudan University, Shanghai, China.
Endosc Ultrasound. 2020 May-Jun;9(3):180-186. doi: 10.4103/eus.eus_9_20.
In the recent years, EUS is one of the routine procedures in the diagnosis of pancreatic diseases. EUS-guided needle-based confocal laser endomicroscopy (nCLE) is a novel minimally invasive imaging technique in diagnosis of pancreatic diseases. The pilot researches provided us some preliminary findings and conclusions with small samples, low rate of pathological correspondence. The aim of this current study was to evaluate the diagnostic efficacy of EUS-guided nCLE in solid pancreatic lesions (SPLs) and pancreatic cystic lesions (PCLs) based on large samples. The date was obtained on nCLE imaging findings and high rate of correlation with pathology.
Patients enrolled in the study were underwent EUS-nCLE to achieve the nCLE images and diagnosis. Comparing with the final diagnosis, including surgical histopathological results or cyto-/histopathology through FNA, the efficacy and accuracy of nCLE in diagnosis in solid and cystic pancreatic lesions were evaluated. In other cases, clinical diagnoses were achieved based on the combination with clinical history, image findings and fluid analysis and cytology, by 3 independent committee members strongly agreed with a concordant diagnosis.
Totally 172 patients were enrolled into the study. The overall rate of final diagnosis was about 65% while 50% in cystic lesion. The mean sensitivity, specificity, negative predictive value, positive predictive value and accuracy of the nCLE in diagnosis of PDAC is 90.3%, 89.5%, 93.3%, 85.0% and 90.0% respectively. The efficacy and accuracy of pancreatic cystic lesions were very satisfying and some additional nCLE signs were found, including "black aggregates of cells, forming as gland-like structure, surrounding by fibro and vessels" in neuroendocrine tumors (NETs); "black columnar protrusions near vascular area" in the pseudopapillary solid tumor (SPT); macrophage in tuberculosis (TB) and small aggregate of black regular cells maybe corresponds to ovarian-like stroma in mucinous cystadenoma (MCN). In the study, 20 (11.6%) patients suffered complications, including symptomatic (5.2%) and asymptomatic (6.4%).
nCLE observation could improve characterization of indeterminate cysts, or confirm the EUS impression, when cytological confirmation is missing. The technique may deliver information to better guide our clinical decisions.
近年来，超声内镜（EUS）是胰腺疾病诊断中的常规检查方法之一。EUS引导下基于针的共聚焦激光内镜检查（nCLE）是一种用于胰腺疾病诊断的新型微创成像技术。前期研究提供了一些小样本、病理符合率低的初步结果和结论。本研究旨在基于大样本评估EUS引导下nCLE对实性胰腺病变（SPL）和胰腺囊性病变（PCL）的诊断效能。获取了nCLE成像结果及与病理的高相关性数据。
纳入研究的患者接受EUS-nCLE检查以获取nCLE图像并进行诊断。将其与最终诊断结果进行比较，最终诊断包括手术组织病理学结果或经细针穿刺抽吸活检（FNA）获得的细胞/组织病理学结果，评估nCLE对实性和囊性胰腺病变诊断的效能及准确性。在其他情况下，由3名独立委员会成员根据临床病史、影像表现、液体分析和细胞学检查结果综合判断得出临床诊断，并强烈认可一致的诊断结果。
共172例患者纳入本研究。最终诊断的总体比例约为65%，而囊性病变为50%。nCLE诊断胰腺导管腺癌（PDAC）的平均敏感性、特异性、阴性预测值、阳性预测值和准确性分别为90.3%、89.5%、93.3%、85.0%和90.0%。胰腺囊性病变的诊断效能和准确性非常令人满意，还发现了一些额外的nCLE征象，包括神经内分泌肿瘤（NET）中“黑色细胞聚集体，形成腺样结构，周围有纤维组织和血管”；假乳头状实性肿瘤（SPT）中“血管区域附近的黑色柱状突起”；结核（TB）中的巨噬细胞以及黏液性囊腺瘤（MCN）中可能对应卵巢样间质的黑色规则细胞小聚集体。本研究中，20例（11.6%）患者出现并发症，包括有症状的（5.2%）和无症状的（6.4%）。
当缺乏细胞学确诊时，nCLE观察可改善对不确定囊肿的特征描述，或确认EUS的印象。该技术可为临床决策提供更好的指导信息。
