Kunal Karia, MD from the Division of Gastroenterology and Hepatology at Weill Cornell
Medical College in New York, New York discusses “Needle-based confocal endomicroscopy for pancreatic cysts: the current agreement in interpretation.”

With the increasing use of abdominal cross-sectional imaging, more and more pancreatic cystic lesions (PCLs) are being identified.  Accurate diagnosis and understanding the malignant potential of these lesions is paramount to determining whether to refer for surgical excision or to continue ongoing surveillance.  EUS-FNA of cystic lesions for fluid analysis, tumor markers, and cytology is limited by sampling error and non-diagnostic samples.

Needle-based confocal laser endomicroscopy (nCLE) allows for real-time, optical biopsies with the potential to increase diagnostic yield at the time of EUS.  In fact, previous studies have shown that certain imaging characteristics when present are 100% specific for mucinous cystic neoplasms and serous cystadenomas.

The employment of nCLE in the diagnosis of PCLs requires adequate training and experience in image interpretation.  The goal of our study was to identify the interobserver agreement (IOA) of nCLE in the hands of expert endoscopists.

The IOA was fair to poor for nCLE of PCLs with a mean accuracy of 46%.  The  results may be partially due to the heterogenous presentation of PCLs, an inability to image the entire PCL via nCLE, and the lack of clinical/radiologic/cyst fluid analysis provided to those reviewing nCLE images.

A, nCLE imaging showing intraductal papillary mucinous neoplasm. B, nCLE imaging showing intraductal papillary mucinous neoplasm with high-grade dysplasia. C, nCLE imaging showing pancreatic adenocarcinoma.

This study highlights the natural learning curve inherit with new technology.  Future studies aimed at developing refined image interpretation criteria are needed to improve IOA and accuracy.

Read the abstract online.

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