Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts

Yang, Dennis; Trindade, Arvind J.; Yachimski, Patrick; Benias, Petros C.; Nieto, José; Manvar, Amar; Ho, Sammy; Esnakula, Ashwini; Gamboa, Anthony; Sethi, Amrita; Gupte, Anand; Khara, Harshit S.; Diehl, David L.; Chafic, Abdul El; Shah, Janak N.; Forsmark, Christopher E.; Draganov, Peter V.

doi:10.1016/j.cgh.2018.11.027

Cited by 70 publications

(83 citation statements)

References 34 publications

(53 reference statements)

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“…Nevertheless, this would probably not have affected the results because the patients included in our cohort were sent for EUS-FNA after inconclusive CT and MRI. (3) We did not include in our study new PCLs diagnostic tools for which the potential interests have been published during the conduct of the study, including DNA mutations [25,26], string sign tests [27], and EUS-guided microforceps biopsies [28]. (4) For the sake of simplification, therapeutic management was based on a consensus of a panel of five experts.…”

Section: Discussionmentioning

confidence: 99%

Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions

et al. 2019

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Background and aim The diagnosis and therapeutic management of large single pancreatic cystic lesions (PCLs) represent major issues for clinicians and essentially rely on endoscopic ultrasound fine-needle aspiration (EUS-FNA) findings. Needlebased confocal laser endomicroscopy (nCLE) has high diagnostic performance for PCLs. This study aimed to evaluate the impact of nCLE on the therapeutic management of patients with single PCLs. Methods Retrospective and comparative study. Five independent pancreatic disease experts from tertiary hospitals independently reviewed data from a prospective database of 206 patients with single PCL, larger than 2 cm and who underwent EUS-FNA and nCLE. Two evaluations were performed. The first one included the sequential review of clinical information, EUS report and FNA results. The second one included the same data + nCLE report. Participants had to propose a therapeutic management for each case. Results The addition of nCLE to EUS-FNA led to significant changes in therapeutic management for 28% of the patients (p < 0.001). nCLE significantly increased the interobserver agreement of 0.28 (p < 0.0001), from 0.36 (CI 95% 0.33-0.49) to 0.64 (CI 95% 0.61-0.67). nCLE improved the rates of full agreement among the five experts of 24% (p < 0.0001), from 30 to 54%. With nCLE, the surveillance rate of benign SCAs fell by 35%, from 40 (28/70) to 5% (4/76). Conclusion The addition of nCLE to EUS-FNA significantly improves reliability of PCL diagnosis and could impact the therapeutic management of patients with single PCLs. ClinicalTrials.gov number, NCT01563133.Keywords EUS-FNA · Pancreatic cysts · Needle-based confocal laser endomicroscopy Abbreviations BD-IPMN Branch duct-intraductal papillary mucinous neoplasm CT Computed tomography CEA Carcinoembryonic antigen EUS-FNA Endoscopic ultrasound fine-needle aspiration IML Indeterminate mucinous lesion MCN Mucinous cystic neoplasm MRI Magnetic resonance imaging nCLE Needle-based confocal laser endomicroscopy NEN Neuroendocrine neoplasm PC Pseudocyst PCLs Pancreatic cystic lesions SCA Serous cystadenoma The therapeutic management of pancreatic cystic lesions (PCL) depends on the cyst type. Surveillance or surgical and Other Interventional TechniquesPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 99%

Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions

et al. 2019

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“…In all cases, bleeding was self-limiting and asymptomatic and did not require medical intervention. Three moderate AEs were recorded, two by Kovacevic et al [17] and one by Yang et al [20]. All were mild acute pancreatitis.…”

Section: Studymentioning

confidence: 95%

“…All 3 cases of moderate adverse events were mild acute pancreatitis. In the study of Yang et al [20], one patient developed a pseudocyst several weeks later that required endoscopic drainage, the patient recovered after stent removal without recurrence.…”

Section: Adverse Eventsmentioning

confidence: 98%

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

et al. 2020

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Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs. Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis). Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %). Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

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“…Sensitivities for diagnosing mucinous cyst and malignant transformation using cyst fluid obtained by EUS‐FNA were not particularly high. Recently, EUS‐guided through‐the‐needle microforces biopsy was reported to improve the pathological yields and showed better diagnostic potential than that with EUS‐FNA . Further evaluation of this technique is required, as diagnostic yields might be limited considering possible patchy distribution of specific pathological findings for differential diagnosis on the cyst wall.…”

Section: Eus‐fna For Differential Diagnosis and Detection Of Malignanmentioning

confidence: 99%

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

Iwashita

Uemura

Mita

et al. 2019

Digestive Endoscopy

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Recent advances and frequent use of cross‐sectional imaging studies have increased opportunities for incidental diagnoses of pancreatic cystic lesions (PCL). In the management of PCL, distinguishing between mucinous versus non‐mucinous and malignant versus benign cysts is important to diagnose pancreatic cancer in its early stage. For this reason, there have been several guidelines to manage PCL. Endoscopic ultrasound (EUS) and EUS‐guided fine‐needle aspiration (FNA) play important roles in the guidelines, although there are some differences in their roles. In this review, we aimed to evaluate the current status of EUS and EUS‐FNA in the management of PCL and the status of these procedures in the guidelines.

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Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts

Cited by 70 publications

References 34 publications

Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions

Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

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