Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study.

Abstract

BACKGROUND:

The diagnosis of pancreatic cystic neoplasms (PCNs), which now depends on morphology, cytology, and fluid analysis, is still challenging. A novel confocal laser endomicroscopy probe that can be inserted through a 19-gauge FNA needle allows needle-based confocal laser endomicroscopy (nCLE), and the feasibility of nCLE has been reported in PCNs. The combination of cystoscopy by using a through-the-needle fiberoptic probe in combination with nCLE under EUS guidance may improve the diagnosis of PCNs.

OBJECTIVE:

To assess the feasibility, safety, and diagnostic yield of the combination of cystoscopy and nCLE in the clinical diagnosis of PCNs.

DESIGN:

A prospective feasibility study.

SETTING:

An academic tertiary referral center.

PATIENTS:

Thirty patients with PCNs.

INTERVENTIONS:

EUS-guided dual through-the-needle imaging (cystoscopy and nCLE) for PCNs.

MAIN OUTCOME MEASUREMENTS:

Technical feasibility and safety. Associations of cystoscopy and nCLE findings with clinical diagnosis of PCNs.

RESULTS:

The procedure was technically successful with the exception of 1 probe exchange failure. In 2 patients (7%), postprocedure pancreatitis developed. Specific features associated with the clinical diagnosis of mucinous cysts were identified: mucin on cystoscopy and papillary projections and dark rings on nCLE. The sensitivity of cystoscopy was 90% (9/10), and that of nCLE was 80% (8/10), and the combination was 100% (10/10) in 18 high-certainty patients.

LIMITATIONS:

A single-center study and lack of complete pathologic correlation.

CONCLUSION:

The combination of dual through-the-needle imaging (cystoscopy and nCLE) of pancreatic cysts appears to have strong concordance with the clinical diagnosis of PCN.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT01447238.).

• Authors: Yousuke Nakai, Takuji Iwashita, Do Hyun Park, Jason B Samarasena, John G Lee, Kenneth J Chang
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 81 Issue 5 Pg. 1204-14 (May 2015) ISSN: 1097-6779 [Electronic] United States
• PMID: 25634486 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Feasibility Studies
• Female
• Humans
• Male
• Microscopy, Confocal
• Middle Aged
• Pancreatic Neoplasms (diagnostic imaging, pathology)
• Prospective Studies