Pancreatic Cysts: Diagnostic Role of EUS-Guided Microforceps Biopsy and Confocal Laser Endomicroscopy

Kohoutová, Darina; Zar, Sameer; Repák, Rudolf; Vlavianos, Panagiotis; Bureš, Jan

doi:10.1155/2019/3431048

Cited by 14 publications

(13 citation statements)

References 68 publications

(104 reference statements)

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“…prising given a novel technique. Use of microceps biopsy may help to overcome limited cellularity of the EUS-guided cyst fluid aspiration and traditional cytology [60].…”

Section: Discussionmentioning

confidence: 99%

“…Although low-to-moderate-heterogeneity was noted for some variables in our meta-analysis which is not surprising given the cumulative nature of reporting results, this is not surprising given a novel technique. Use of microceps biopsy may help to overcome limited cellularity of the EUS-guided cyst fluid aspiration and traditional cytology 60 .…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis

McCarty

Rustagi

2020

Endosc Int Open

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Background and study aims Given variable diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for pancreatic cystic lesions (PCLs), a through-the-needle (TTN) microforceps biopsy device passed through a 19-gauge FNA needle has been devised to improve tissue sampling. This was a systematic review and meta-analysis to evaluate the feasibility, diagnostic yield, and safety of EUS-guided TTN microforceps biopsy for diagnosis of PCLs. Methods Individualized searches were developed in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, diagnostic yield, accuracy, and procedure-associated adverse events (AEs) as well as comparison to conventional FNA. Results Eleven studies (n = 518 patients; mean age 64.13 ± 5.83 years; 58.19 % female) were included. Mean PCL size was 33.39 ± 3.72 mm with the pancreatic head/uncinate (35.50 %) being the most common location. A mean of 2.47 ± 0.92 forceps passes were performed with a mean of 2.79 ± 0.81 microbiopsies obtained per lesion. Pooled technical success was 97.12 % (95 % CI, 93.73–98.71; I2 = 34.49) with a diagnostic yield of 79.60 % (95 % CI, 72.62–85.16; I2 = 56.00), and accuracy of 82.76 % [(95 % CI, 77.80–86.80; I2 = 0.00). The pooled serious adverse event rate was 1.08 % (95 % CI, 0.43–2.69; I2 = 0.00). Compared to conventional FNA, TTN microforceps biopsy resulted in significant improvement in diagnostic yield [OR 4.79 (95 % CI: 1.52–15.06; P = 0.007)] and diagnostic accuracy [OR 8.69 (95 % CI, 1.12–67.12; P = 0.038)], respectively. Conclusions EUS-guided TTN microforceps biopsy appears to be safe and effective for diagnosis of PCLs with improvement in diagnostic yield and accuracy when compared to FNA alone.

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“…prising given a novel technique. Use of microceps biopsy may help to overcome limited cellularity of the EUS-guided cyst fluid aspiration and traditional cytology [60].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis

McCarty

Rustagi

2020

Endosc Int Open

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“…Thus, EUS is helpful for identifying PCN with features that should be considered for surgical resection, but the value of EUS without other advanced technologies (i.e. microforceps biopsy and confocal laser endomicroscopy) are limited. However, these technologies are not recommended by EEG or ACGG.…”

Section: Discussionmentioning

confidence: 99%

Validation of European evidence‐based guidelines and American College of Gastroenterology guidelines as predictors of advanced neoplasia in patients with suspected mucinous pancreatic cystic neoplasms

Sun

Wang

et al. 2020

J of Gastro and Hepatol

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Background and Aim: The European evidence-based guidelines (EEG) and American College of Gastroenterology Guidelines (ACGG) have been published to guide the management of pancreatic cystic lesions. We aim to evaluate the value of both guidelines in predicting advanced pancreatic cystic lesions (A-PCLs) with preoperatively imagingsuspected cystic mucinous pancreatic neoplasms (cMNs). Methods: One hundred ninety-eight patients who underwent resections from 2013 to 2019 for suspected cMNs were retrospectively reviewed. Receiver operating characteristic curves were calculated and compared with measure diagnostic value. Results: Sixty-two patients were diagnosed with A-PCLs pathologically. Cross-imaging modalities had comparable diagnostic accuracy to endoscopic ultrasound in type classification and A-PCLs prediction. Receiver operating characteristic curve comparison analyses showed that EEG absolute + MCN (EEG AM) and EEG relative + MCN (EEG RM) having at least one indications criteria were comparable to the ACGG (P = 0.21 and P = 0.45). For the criteria having at least two indications, ACGG was superior to EEG AM (P = 0.001) but comparable to EEG RM (P = 0.12). EEG AM ≥ 1 indication criteria was superior to ≥ 2 indications criteria (P = 0.02). EEG RM ≥ 1 indication criteria had comparable diagnostic performance with ≥ 2 indications criteria (P = 0.86). ACGG ≥ 2 indications criteria was superior to ≥ 1 indication criteria (P = 0.02). Conclusion: On the basis of cross-imaging evaluations, both sets of guidelines were found to be helpful in identifying A-PCLs in suspected cMNs with comparable performance. EEG AM ≥ 1 indication criteria was superior to ≥ 2 indications criteria. ACGG ≥ 2 indications criteria was superior to ≥ 1 indication criteria.

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“…[ 67 ] The data in this meta-analysis were similar to the data obtained in other meta-analyses. [ 106 107 108 109 ]…”

Section: Novel Eus-guided Tissue Acquisition Techniquesmentioning

confidence: 99%

Application of EUS-based techniques in the evaluation of pancreatic cystic neoplasms

2021

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Pancreatic cystic neoplasms (PCNs) are being detected increasingly frequently due to the widespread use of high-resolution abdominal imaging modalities. Some subtypes of PCNs have the potential for malignant transformation. Therefore, accurate diagnosis of PCNs is crucial to determine whether surgical resection or surveillance is the best management strategy. However, the current cross-section imaging modalities are not accurate enough to enable definite diagnoses. In the last decade, EUS-based techniques have emerged, aiming to overcome the limitations of standard cross-section imaging modalities. These novel EUS-based techniques were primarily designed to acquire distinct images to make radiological diagnoses, collect cyst fluid to undergo biochemical or molecular analyses, and obtain tissue to conclude the pathological diagnoses. In this article, we present a comprehensive and critical review of these emerging EUS techniques for the diagnosis of PCNs, with emphasis being placed on the advantages, feasibilities, diagnostic performances, and limitations of these novel techniques.

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Pancreatic Cysts: Diagnostic Role of EUS-Guided Microforceps Biopsy and Confocal Laser Endomicroscopy

Cited by 14 publications

References 68 publications

Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis

Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis

Validation of European evidence‐based guidelines and American College of Gastroenterology guidelines as predictors of advanced neoplasia in patients with suspected mucinous pancreatic cystic neoplasms

Application of EUS-based techniques in the evaluation of pancreatic cystic neoplasms

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