Impact of EUS-guided microforceps biopsy sampling and needle-based confocal laser endomicroscopy on the diagnostic yield and clinical management of pancreatic cystic lesions - 20/04/20
Abstract |
Background and Aims |
EUS-guided microforceps biopsy sampling (MFB) and needle-based confocal laser endomicroscopy (nCLE) are emerging diagnostic tools for pancreatic cystic lesions (PCLs). There is a paucity of data regarding their performance and impact. The aim of this study was to compare diagnostic outcomes and changes in clinical management resulting from MFB and nCLE use in PCLs.
Methods |
This was a single-center retrospective study of patients with PCLs who underwent combined EUS-guided FNA, MFB, and nCLE. Primary outcomes included diagnostic yield (specific PCL type) and change in clinical management for each modality compared with the current “composite standard” (CS) obtained by combining clinical, morphologic, cyst fluid cytology, and chemical analysis.
Results |
Forty-four cysts were studied in 44 patients. Technical success was 100% for EUS-FNA, 88.6% for MFB, and 97.7% for nCLE. Of 44 procedures, there was 1 adverse event (2.3%, an infected pseudocyst). Diagnostic yield for each individual modality was 34.1% for CS, 75.0% for MFB (P < .05 vs CS), and 84.1% for nCLE (P < .05 vs CS). Diagnostic yield for combined tests was 79.5% for CS/MFB, 88.6% for CS/nCLE, and 93.2% for CS/MFB/nCLE (P = not significant). Compared with the CS, the use of MFB, nCLE, and their combination led to overall change in clinical management in 38.6%, 43.2%, and 52.3% of cases, respectively. MFB and nCLE led to an overall increase in discontinuation of surveillance (MFB, 34.1% [P < .05]; nCLE, 31.8% [P < .05]), led by a reduction in the indication for follow-up radiologic or endoscopic studies (MFB, 34.1% [P < .05]; nCLE, 38.6% [P < .05]). Based on MFB and nCLE, 2 of 28 (7.1%) and 3 of 28 (10.7%) patients who would have undergone further surveillance were referred for surgery.
Conclusions |
In the evaluation of PCLs, the use of combined EUS-guided FNA, MFB, and nCLE is safe. MFB and nCLE led to significant improvements in specific PCL diagnosis, which in turn has major impacts in clinical management.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : CEA, CS, MFB, nCLE, PD, PCL
Mappa
| DISCLOSURE: The following authors disclosed financial relationships: A. R. Cheesman: Expenses from Olympus. N. A. Kumta: Consultant for Boston Scientific, Olympus, Apollo Endosurgery, and Gyrus Acmi, Inc; speaker for Boston Scientific and Apollo Endosurgery; expenses from Boston Scientific, Olympus, EndoGastric Solutions, and Gyrus Acmi, Inc. C. J. DiMaio: Consultant and speaker for Boston Scientific and Medtronic; expenses from Boston Scientific, Cook Medical, EndoGastric Solutions, and US Endoscopy. All other authors disclosed no financial relationships. |
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| See CME section; p. 1187. |
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| If you would like to chat with an author of this article, you may contact Dr DiMaio at [email protected]. |
Vol 91 - N° 5
P. 1095-1104 - maggio 2020 Ritorno al numero
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