A Practical Strategy to Reduce Surgical Overtreatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Chang, Jenny H.; Wehrle, Chase; Hossain, Mir Shanaz; Woo, Kimberly; Stackhouse, Kathryn; Augustin, Toms; Simon, Robert; Joyce, Daniel; Fleming, Jason B; Naffouje, Samer A.

doi:10.1097/sla.0000000000006133

Cited by 1 publication

(1 citation statement)

References 10 publications

(17 reference statements)

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“…The traditional diagnostic modalities used to evaluate pancreatic cysts, incorporated into the widely accepted consensus guidelines (Fukuoka Criteria and recent Kyoto Guidelines), diagnose the presence of high-grade dysplasia in IPMNs with an accuracy of 65–75% (low sensitivity but high specificity) [ 9 , 10 ]. As a result, approximately 60% of IPMNs undergoing a surgical resection for suspected high-grade dysplasia end up having only low-grade dysplasia, which translates into overtreatment and unnecessary surgeries (assuming there would not have been future malignant transformation) [ 11 , 12 ]. Notably, the rates of morbidity associated with pancreatectomies are high, including pancreatic duct leaks, bleeding, infection in the short term, as well as exocrine pancreatic insufficiency and diabetes mellitus in the long-term [ 13 ].…”

Section: Diagnosis Of Mucinous Lesionsmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms

Krishna,

Abdelbaki,

Hart

et al. 2024

Cancers

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Pancreatic cancer is on track to become the second leading cause of cancer-related deaths by 2030, yet there is a lack of accurate diagnostic tests for early detection. Intraductal papillary mucinous neoplasms (IPMNs) are precursors to pancreatic cancer and are increasingly being detected. Despite the development and refinement of multiple guidelines, diagnosing high-grade dysplasia or cancer in IPMNs using clinical, radiologic, endosonographic, and cyst fluid features still falls short in terms of accuracy, leading to both under- and overtreatment. EUS-guided needle-based confocal laser endomicroscopy (nCLE) is a novel technology that allows real-time optical biopsies of pancreatic cystic lesions. Emerging data has demonstrated that EUS-nCLE can diagnose and risk stratify IPMNs more accurately than conventional diagnostic tools. Implementing EUS-nCLE in clinical practice can potentially improve early diagnosis of pancreatic cancer, reduce unnecessary surgeries of IPMNs with low-grade dysplasia, and advance the field of digital pathomics. In this review, we summarize the current evidence that supports using EUS-nCLE as a diagnostic imaging biomarker for diagnosing IPMNs and for risk stratifying their degree of neoplasia. Moreover, we will present emerging data on the role of adding artificial intelligence (AI) algorithms to nCLE and integrating novel fluid biomarkers into nCLE.

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