Endoscopy 2015; 47(01): 26-32
DOI: 10.1055/s-0034-1390693
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy

Bertrand Napoléon
1  Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
,
Anne-Isabelle Lemaistre
2  Department of Biopathology, Centre Léon Bérard, Lyon, France
,
Bertrand Pujol
1  Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
,
Fabrice Caillol
3  Department of Hepatogastroenterology, Institut Paoli Calmettes, Marseille, France
,
Damien Lucidarme
4  Medicosurgical Department of Hepatogastroenterology, Saint-Philibert Hospital Centre, Lomme-lès-Lille, France
,
Raphaël Bourdariat
5  Department of Digestive Surgery, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
,
Blandine Morellon-Mialhe
2  Department of Biopathology, Centre Léon Bérard, Lyon, France
,
Fabien Fumex
1  Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
,
Christine Lefort
1  Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
,
Vincent Lepilliez
1  Department of Gastroenterology, Hôpital privé Jean Mermoz, Générale de Santé, Lyon, France
,
Laurent Palazzo
6  Department of Gastroenterology, Clinique du Trocadéro, Paris, France
,
Geneviève Monges
7  Department of Biopathology, Institut Paoli Calmettes, Marseille, France
,
Bernard Filoche
4  Medicosurgical Department of Hepatogastroenterology, Saint-Philibert Hospital Centre, Lomme-lès-Lille, France
,
Marc Giovannini
3  Department of Hepatogastroenterology, Institut Paoli Calmettes, Marseille, France
› Author Affiliations
Further Information

Publication History

submitted 14 January 2014

accepted after revision 06 August 2014

Publication Date:
17 October 2014 (online)

Background and study aims: The differential diagnosis of solitary pancreatic cystic lesions is frequently difficult. Needle-based confocal laser endomicroscopy (nCLE) performed during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a new technology enabling real-time imaging of the internal structure of such cysts. The aim of this pilot study was to identify and validate new diagnostic criteria on nCLE for pancreatic cystic lesions.

Patients and methods: A total of 31 patients with a solitary pancreatic cystic lesion of unknown diagnosis were prospectively included at three centers. EUS-FNA was combined with nCLE. The final diagnosis was based on either a stringent gold standard (surgical specimen and/or positive cytopathology) or a committee consensus. Six nonblinded investigators reviewed nCLE sequences from patients with the most stringent final diagnosis, and identified a single feature that was only present in serous cystadenoma (SCA). The findings were correlated with the pathology of archived specimens. After a training session, four blinded independent observers reviewed a separate independent video set, and the yield and interobserver agreement for the criterion were assessed.

Results: A superficial vascular network pattern visualized on nCLE was identified as the criterion. It corresponded on pathological specimen to a dense and subepithelial capillary vascularization only seen in SCA. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this sign for the diagnosis of SCA were 87 %, 69 %, 100 %, 100 %, and 82 %, respectively. Interobserver agreement was substantial (κ = 0.77).

Conclusion: This new nCLE criterion seems highly specific for the diagnosis of SCA. The visualization of this criterion could have a direct impact on the management of patients by avoiding unnecessary surgery or follow-up.

Clinicaltrials.gov NCT01563133.