Appraisal of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic cysts

Nearly 2.5% of cross-sectional imaging studies will report a finding of a cystic pancreatic lesion. Even though most of these are incidental findings, it remains very concerning for both patients and treating clinicians. Differentiating and predicting malignant transformation in pancreatic cystic le...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2016-01, Vol.22 (4), p.1701-1710
Main Authors: Krishna, Somashekar G, Lee, Jeffery H
Format: Article
Language:English
Subjects:
Diagnosis, Differential
Endoscopic Ultrasound-Guided Fine Needle Aspiration - adverse effects
Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods
Humans
Image Interpretation, Computer-Assisted
Microscopy, Confocal - methods
Minireviews
Observer Variation
Pancreatic Cyst - pathology
Predictive Value of Tests
Prognosis
Reproducibility of Results
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Summary:Nearly 2.5% of cross-sectional imaging studies will report a finding of a cystic pancreatic lesion. Even though most of these are incidental findings, it remains very concerning for both patients and treating clinicians. Differentiating and predicting malignant transformation in pancreatic cystic lesions is clinically challenging. Current evaluation of suspicious cystic lesions includes a combination of radiologic imaging, endoscopic ultrasound (EUS) and cyst fluid analyses. Despite these attempts, precise diagnostic stratification among non-mucinous, mucinous, and malignant cystic lesions is often not possible until surgical resection. EUS-guided needle based confocal laser endomicroscopy (nCLE) for evaluation of pancreatic cysts is emerging as a powerful technique with remarkable potential. Though limited imaging data from 3 large clinical trials (INSPECT, DETECT and CONTACT) are currently the reference standard for nCLE imaging, nonetheless these have not been validated in large studies. The aim of this review article is to review the evolving role of EUS-guided nCLE in management of pancreatic cystic lesions in terms of its significance, adverse events, limitations, and implications.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v22.i4.1701