In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study

Somashekar G. Krishna, Rohan M. Modi, Amrit K. Kamboj, Benjamin J. Swanson, Phil A. Hart, Mary E. Dillhoff, Andrei Manilchuk, Carl R. Schmidt, Darwin L. Conwell

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

AIM To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS)-guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). METHODS In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQFlex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. CONCLUSION In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

Original languageEnglish (US)
Pages (from-to)3338-3348
Number of pages11
JournalWorld Journal of Gastroenterology
Volume23
Issue number18
DOIs
StatePublished - May 14 2017

Fingerprint

Needles
Prospective Studies
Serous Cystadenoma
Neuroendocrine Tumors
Ferns
Neoplasms
Glandular and Epithelial Neoplasms
Paris
Fluorescein
France
Biomarkers
Biopsy

Keywords

  • Confocal laser endomicroscopy
  • Intraductal papillary mucinous neoplasm
  • Pancreatic cystic neoplasm
  • Pancreatic neuroendocrine tumor
  • Serous cystadenoma

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Krishna, S. G., Modi, R. M., Kamboj, A. K., Swanson, B. J., Hart, P. A., Dillhoff, M. E., ... Conwell, D. L. (2017). In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study. World Journal of Gastroenterology, 23(18), 3338-3348. https://doi.org/10.3748/wjg.v23.i18.3338

In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions : A prospective study. / Krishna, Somashekar G.; Modi, Rohan M.; Kamboj, Amrit K.; Swanson, Benjamin J.; Hart, Phil A.; Dillhoff, Mary E.; Manilchuk, Andrei; Schmidt, Carl R.; Conwell, Darwin L.

In: World Journal of Gastroenterology, Vol. 23, No. 18, 14.05.2017, p. 3338-3348.

Research output: Contribution to journalReview article

Krishna, SG, Modi, RM, Kamboj, AK, Swanson, BJ, Hart, PA, Dillhoff, ME, Manilchuk, A, Schmidt, CR & Conwell, DL 2017, 'In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study', World Journal of Gastroenterology, vol. 23, no. 18, pp. 3338-3348. https://doi.org/10.3748/wjg.v23.i18.3338
Krishna, Somashekar G. ; Modi, Rohan M. ; Kamboj, Amrit K. ; Swanson, Benjamin J. ; Hart, Phil A. ; Dillhoff, Mary E. ; Manilchuk, Andrei ; Schmidt, Carl R. ; Conwell, Darwin L. / In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions : A prospective study. In: World Journal of Gastroenterology. 2017 ; Vol. 23, No. 18. pp. 3338-3348.
@article{6547448aecac4012a4ac5d375dbe9f96,
title = "In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study",
abstract = "AIM To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS)-guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). METHODS In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQFlex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a {"}fern pattern{"} of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. CONCLUSION In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.",
keywords = "Confocal laser endomicroscopy, Intraductal papillary mucinous neoplasm, Pancreatic cystic neoplasm, Pancreatic neuroendocrine tumor, Serous cystadenoma",
author = "Krishna, {Somashekar G.} and Modi, {Rohan M.} and Kamboj, {Amrit K.} and Swanson, {Benjamin J.} and Hart, {Phil A.} and Dillhoff, {Mary E.} and Andrei Manilchuk and Schmidt, {Carl R.} and Conwell, {Darwin L.}",
year = "2017",
month = "5",
day = "14",
doi = "10.3748/wjg.v23.i18.3338",
language = "English (US)",
volume = "23",
pages = "3338--3348",
journal = "World Journal of Gastroenterology",
issn = "1007-9327",
publisher = "WJG Press",
number = "18",

}

TY - JOUR

T1 - In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions

T2 - A prospective study

AU - Krishna, Somashekar G.

AU - Modi, Rohan M.

AU - Kamboj, Amrit K.

AU - Swanson, Benjamin J.

AU - Hart, Phil A.

AU - Dillhoff, Mary E.

AU - Manilchuk, Andrei

AU - Schmidt, Carl R.

AU - Conwell, Darwin L.

PY - 2017/5/14

Y1 - 2017/5/14

N2 - AIM To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS)-guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). METHODS In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQFlex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. CONCLUSION In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

AB - AIM To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS)-guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). METHODS In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQFlex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. CONCLUSION In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.

KW - Confocal laser endomicroscopy

KW - Intraductal papillary mucinous neoplasm

KW - Pancreatic cystic neoplasm

KW - Pancreatic neuroendocrine tumor

KW - Serous cystadenoma

UR - http://www.scopus.com/inward/record.url?scp=85019619698&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019619698&partnerID=8YFLogxK

U2 - 10.3748/wjg.v23.i18.3338

DO - 10.3748/wjg.v23.i18.3338

M3 - Review article

C2 - 28566895

AN - SCOPUS:85019619698

VL - 23

SP - 3338

EP - 3348

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

IS - 18

ER -