Clin Endosc.  2021 Jan;54(1):38-47. 10.5946/ce.2019.200-IDEN.

The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review

• Chin YK
• Wu CCH
• Tan DMY

• KMID: 2512308
• DOI: http://doi.org/10.5946/ce.2019.200-IDEN

Abstract

The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominal imaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs that require surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriately aggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopic examination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE and histological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed the high diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown to improve the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity and mortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes for pancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate management have resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantly improved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of the pancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.

Keyword

Cost effectiveness; Endoscopic ultrasound; Fine needle aspiration; Needle-based confocal laser endomicroscopy; Pancreatic cyst

Figure

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  Fig. 1. The AQ-Flex (Cellvizio, Mauna Kea Technologies, Paris, France) 19 needle confocal laser endomicroscopy miniprobe.

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  Fig. 2. (A) The ferule is a metallic tap at the distal end of the probe that protects the device from the beveled needle tip. (B) The sheath of the probe comprises a robust protective biocompatible coating. (C) A locking device is attached by a Luer lock to the fine needle aspiration needle’s proximal hub and secured onto the probe to maintain needle position and prevent migration.

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  Fig. 3. Superficial vascular network visible on needle-based confocal laser endomicroscopy of serous cystadenoma.

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  Fig. 4. Papillary projections characterized by a vascular core (white) surrounded by an epithelial border (gray) are visible on needle-based confocal laser endomicroscopy of intraductal papillary mucinous neoplasm.

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  Fig. 5. A thick epithelial band is visible on needle-based confocal laser endomicroscopy of mucinous cystadenoma.

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  Fig. 6. Bright uniform particles are visible against a dark background on needle-based confocal laser endomicroscopy of pseudocyst.

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