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Confocal laser endomicroscopy in diagnosing indeterminate biliary strictures and pancreatic lesions − a prospective pilot study

Česká verzia

Authors: J. Martínek 1;  M. Kollár 2;  J. Krajčíová 1;  J. Malušková 2;  T. Hucl 1;  Z. Vacková 1;  R. Husťak 3;  J. Ušák 3;  L. Hadraba 4;  R. Uhlíř 5;  J. Špičák 1
Authors place of work: Klinika hepatogastroenterologie, Institut klinické a experimentální chirurgie (IKEM), Praha 1;  Pracoviště klinické a transplantační patologie, Institut klinické a experimentální chirurgie (IKEM), Praha 2;  Interní klinika, Fakultní nemocnice Trnava 3;  Interní oddělení, Nemocnice Teplice 4;  Imedex Česká republika, Hradec Králové 5
Published in the journal: Rozhl. Chir., 2020, roč. 99, č. 6, s. 258-265.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2020.99.6.258–265

Summary

Introduction: An accurate histopathological diagnosis of indeterminate biliary strictures and pancreatic lesions is challenging because of insufficient quali­ty of tissue specimen taken during ERCP (brush cytology), cholangioscopy (biopsies) or endosonography (EUS, FNAB). Confocal laser endomicroscopy (CLE) allows virtual histopathological diagnosis with the potential to either replace or increase the diagnostic yield of standard histopathological diagnosis in patients presenting with biliary strictures and pancreatic lesions. The aims of our prospective pilot study were to: 1. Assess the diagnostic yield of standard histopathology compared to CLE in patients referred for cholangioscopy or for EUS of the pancreas; 2. Evaluate the cost of CLE in these indications.

Methods: CLE was performed (during cholangioscopy or EUS), followed by standard tissue sampling. CLE-based diagnosis was compared with standard histopathology/cytology. CLE probe was introduced through the working channel of the cholangioscope or through the FNAB needle.

Results: A total of 23 patients were enrolled (12 women, mean age 61 years); 13 patients underwent cholangioscopy and 10 patients underwent EUS. Cholangioscopy: CLE diagnosed correctly all 4 malignant strictures (histology 2 of them only as 2 patients had insufficient quality of the tissue specimen). Agreement between standard histopathology and CLE was achieved in 85 %. EUS: All 3 cases of pancreatic cancer were correctly diagnosed by both CLE and FNAB. All remaining (premalignant and benign) lesions were also correctly diagnosed by both methods.

The cost of CLE examination is higher compared to FNAB but comparable with tissue sampling during digital cholangioscopy.

Conclusion: CLE demonstrated sufficient diagnostic accuracy in patients with indeterminate biliary strictures or pancreatic lesions and, therefore, might improve diagnostic accuracy or even replace standard histopathology in these indications.

Keywords:

confocal laser endomicroscopy − biliary stricture − cystic pancreatic lesion

Zdroje
  1. Kollár M, Krajčíová J, Husťak R, et al. Confocal laser endomicroscopy in the diagnostics of gastrointestinal lesions – literary review and personal experience. Rozhl Chir. 2018;97(12):531−538.
  2. Wang KK, Carr-Locke DL, Singh SK, et al. Use of probe-based confocal laser endomicroscopy (pCLE) in gastrointestinal applications. A consensus report based on clinical evidence. United European Gastroenterol J. 2015;3(3):230−254. doi: 10.1177/2050640614566066.
  3. Kollar M, Spicak J, Honsova E, et al. Role of confocal laser endomicroscopy in patients with early esophageal neoplasia. Minerva Chir. 2018;73(4):417−427. doi: 10.23736/S0026-4733.18.07795-7.
  4. Krishna SG, Hart PA, DeWitt JM, et al. EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video). Gastrointest Endosc. 2020;91(3):551-563.e5. doi: 10.1016/j.gie.2019.09.014.
  5. Giovannini M, Caillol F, Monges G, et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in solid pancreatic masses. Endoscopy 2016;48(10):892−898. doi: 10.1055/s-0042-112573.
  6. Krishna SG, Brugge WR, Dewitt JM, et al. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointest Endosc. 2017;86(4):644−654.e2. doi: 10.1016/j.gie.2017.03.002.
  7. Slivka A, Gan I, Jamidar P, et al. Validation of the diagnostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study. Gastrointest Endosc. 2015;81(2):282−290. doi: 10.1016/j.gie.2014.10.009.
  8. Navaneethan U, Hasan MK, Lourdusamy V, et al. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015;82(4):608−614.e2. doi: 10.1016/j.gie.2015.04.030.
  9. Yoshinaga S, Suzuki H, Oda I, et al. Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc. 2011;23 Suppl 1:29−33. doi: 10.1111/j.1443-1661.2011.01112.x.
  10. Hucl T, Wee E, Anuradha S, et al. Feasibility and efficiency of a new 22G core needle: a prospective comparison study. Endoscopy 2013;45(10):792−798. doi: 10.1055/s-0033-1344217.
  11. Löhr JM, Lönnebro R, Stigliano S, et al. Outcome of probe-based confocal laser endomicroscopy (pCLE) during endoscopic retrograde cholangiopancreatography: A single-center prospective study in 45 patients. United European Gastroenterol J. 2015;3(6):551−560. doi: 10.1177/2050640615579806.
  12. Yang JF, Sharaiha RZ, Francis G, et al. Diagnostic accuracy of directed cholangioscopic biopsies and confocal laser endomicroscopy in cytology-negative indeterminate bile duct stricture: a multicenter comparison trial. Minerva Gastroenterol Dietol. 2016;62(3):227−233.
  13. Meining A, Shah RJ, Slivka A. Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures. Endoscopy 2012;44:251–257.
  14. Taunk P, Singh S, Lichtenstein D, et al. Improved classification of indeterminate biliary strictures by probe-based confocal laser endomicroscopy using the Paris Criteria following biliary stenting. J Gastroenterol Hepatol. 2017;32(10):1778−1783. doi: 10.1111/jgh.13782.
  15. Napoleon B, Lemaistre AI, Pujol B, et al. In vivo characterization of pancreatic cystic lesions by needle-based confocal laser endomicroscopy (nCLE): proposition of a comprehensive nCLE classification confirmed by an external retrospective evaluation. Surg Endosc. 2016;30:2603– 2612. doi: 10.1007/s00464-015-4510-5.
  16. Navaneethan U, Njei B, Lourdusamy V, et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures—a systematic review and meta-analysis. Gastrointest Endosc. 2015;81(1):168−176. doi: 10.1016/j.gie.2014.09.017.
  17. Bang JY, Navaneethan U, Hasan M, et al. Optimizing outcomes of single-operator cholangioscopy-guided biopsies based on a randomized trial. Clin Gastroenterol Hepatol. 2020;18(2):441−448.e1. doi: 10.1016/j.cgh.2019.07.035.
  18. Hustak R, Král J, Neumann F, et al. Single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: Results from the multicenter Czech and Slovak National Database. Gastrointest Endoscopy 201;85(5):AB641.
  19. Lenze F, Bokemeyer A, Gross D, et al. Safety, diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy. United European Gastroenterol J. 2018;6(6):902−909. doi: 10.1177/2050640618764943.
  20. Barresi L, Crinò SF, Fabbri C, et al. Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A multicenter study. Dig Endosc. 2018;30(6):760−770. doi: 10.1111/den.13197.
  21. Donevan R. Westerveld, Sandeep A, et al. Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis. Endosc Int Open 2020; 8(5):E656–E667. doi: 10.1055/a-1119-6543.
  22. Dušková J, Krechler T, Dvořák M. Endoscopic ultrasound-guided fine needle aspiration biopsy of pancreatic lesions. An 8-year analysis of single institution material focusing on efficacy and learning progress. Cytopatho­logy 2017;28(2):109−115. doi: 10.1111/cyt.12375.
  23. Kollar M, Krajciova J, Prefertusova L, et al. Probe-based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist-blinded study. United European Gastroenterol J. 2020;8(4):436−443. doi: 10.1177/2050640620904865.
  24. Palazzo M, Sauvanet A, Gincul R, et al. Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions. Surg Endosc. 2020;34(6):2532−2540. doi: 10.1007/s00464-019-07062-9. [Epub ahead of print]
  25. Kadayifci A, Atar M, Yang M, et al. Imaging of pancreatic cystic lesions with confocal laser endomicroscopy: an ex vivo pilot study. Surg Endosc. 2017;31(12):5119−5126. doi: 10.1007/s00464-017-5577-y.
  26. Kornblau IS, El-Annan JF. Adverse reactions to fluorescein angiography: A comprehensive review of the literature. Surv Ophthalmol. 2019;64(5):679−693. doi: 10.1016/j.survophthal.2019.02.004.
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