Confocal Laser Endomicroscopy Interpretation and Differentiation of Pancreatic Cysts: A Randomized Trial of Teaching Modalities

Luthra, Anjuli; Pusateri, Antoinette; Pfeil, Sheryl; Groce, J. Royce; Hussan, Hisham; Stanich, Peter P.; Strobel, Sebastian; Patel, Anand; Behzadi, Jennifer; Chan, Megan Q.; Ramsey, Mitchell L.; Ugbarugba, Emmanuel; Allen, Kenneth D.; Patel, Sagar S.; Farah, Filsan; Patel, Arsheya; Vedachalam, Srikanth; Blaszczak, Alecia; Lee, Dana; Porter, Kyle; Krishna, Somashekar G.

doi:10.1016/j.tige.2020.10.003

Cited by 4 publications

(4 citation statements)

References 36 publications

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“…Both teaching methods achieved high diagnostic accuracy (~95%) and substantial interobserver agreement in distinguishing mucinous from non-mucinous pancreatic cysts. These findings were consistent through varying levels of medical training (medical student to academic faculty) [ 20 ]. In a more recent study, which involved 21 early-career endosonographers naive to nCLE, a structured training program was given, followed by assessments using 80 expert-edited videos.…”

Section: Confocal Endomicroscopy and The Diagnosis Of Mucinous Lesionssupporting

confidence: 58%

“…Recent studies have shown that both experienced operators in EUS-nCLE and novices recently trained in nCLE achieve high diagnostic accuracy and agreement on differentiating mucinous from non-mucinous pancreatic cysts and diagnosing specific cyst types [ 17 , 19 , 20 ]. In a recent study involving six endosonographers who were blinded to clinical data while reviewing expert-edited nCLE images from 29 patients (16 mucinous pancreatic cysts, 13 non-mucinous pancreatic cysts), the overall sensitivity, specificity, and accuracy for diagnosing mucinous pancreatic cysts were 95%, 94%, and 95%, respectively.…”

Section: Confocal Endomicroscopy and The Diagnosis Of Mucinous Lesionsmentioning

confidence: 99%

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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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Section: Confocal Endomicroscopy and The Diagnosis Of Mucinous Lesionssupporting

confidence: 58%

Section: Confocal Endomicroscopy and The 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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“…However, we recently demonstrated that a 'trainingand-test' strategy accomplished adequate diagnostic accuracy and IOA among nCLE-naïve observers. 27 Third, the study used multiple sources of prospective data to achieve a large sample size of PCLs with histopathology. However, the larger population of patients provided inclusion of non-IPMN PCLs that were under-represented in prior studies.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions

Machicado

Napoléon²,

Lennon³

et al. 2022

Pancreatology

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“…1 ). Training for image recognition and interpretation takes approximately 6 hours for pCLE and 5 hours for nCLE [ 20 , 21 ]. Three main applications were identified in our systematic review: indeterminate biliary strictures, pancreatic cysts, and pancreatic parenchyma.…”

Section: Resultsmentioning

confidence: 99%

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

et al. 2022

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Background/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for its treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE). Methods: We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations. Results: Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization. Conclusions: CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists. Clin Endosc 2021 Nov 29. [Epub ahead of print]

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Confocal Laser Endomicroscopy Interpretation and Differentiation of Pancreatic Cysts: A Randomized Trial of Teaching Modalities

Cited by 4 publications

References 36 publications

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

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

Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

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