Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos)

Somashekar G. Krishna, William R. Brugge, John M. Dewitt, Pradermchai Kongkam, Bertrand Napoleon, Carlos Robles-Medranda, Damien Tan, Samer El-Dika, Sean McCarthy, Jon Walker, Mary E. Dillhoff, Andrei Manilchuk, Carl Schmidt, Benjamin Swanson, Zarine K. Shah, Phil A. Hart, Darwin L. Conwell

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background and Aims EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. Methods Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. Results A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively. Conclusions EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.)

Original languageEnglish (US)
Pages (from-to)644-654.e2
JournalGastrointestinal Endoscopy
Volume86
Issue number4
DOIs
StatePublished - Oct 2017

Fingerprint

Needles
Lasers
Serous Cystadenoma
Confidence Intervals
Sensitivity and Specificity
Multicenter Studies
Histology
Clinical Trials

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions : an international external interobserver and intraobserver study (with videos). / Krishna, Somashekar G.; Brugge, William R.; Dewitt, John M.; Kongkam, Pradermchai; Napoleon, Bertrand; Robles-Medranda, Carlos; Tan, Damien; El-Dika, Samer; McCarthy, Sean; Walker, Jon; Dillhoff, Mary E.; Manilchuk, Andrei; Schmidt, Carl; Swanson, Benjamin; Shah, Zarine K.; Hart, Phil A.; Conwell, Darwin L.

In: Gastrointestinal Endoscopy, Vol. 86, No. 4, 10.2017, p. 644-654.e2.

Research output: Contribution to journalArticle

Krishna, SG, Brugge, WR, Dewitt, JM, Kongkam, P, Napoleon, B, Robles-Medranda, C, Tan, D, El-Dika, S, McCarthy, S, Walker, J, Dillhoff, ME, Manilchuk, A, Schmidt, C, Swanson, B, Shah, ZK, Hart, PA & Conwell, DL 2017, 'Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos)', Gastrointestinal Endoscopy, vol. 86, no. 4, pp. 644-654.e2. https://doi.org/10.1016/j.gie.2017.03.002
Krishna, Somashekar G. ; Brugge, William R. ; Dewitt, John M. ; Kongkam, Pradermchai ; Napoleon, Bertrand ; Robles-Medranda, Carlos ; Tan, Damien ; El-Dika, Samer ; McCarthy, Sean ; Walker, Jon ; Dillhoff, Mary E. ; Manilchuk, Andrei ; Schmidt, Carl ; Swanson, Benjamin ; Shah, Zarine K. ; Hart, Phil A. ; Conwell, Darwin L. / Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions : an international external interobserver and intraobserver study (with videos). In: Gastrointestinal Endoscopy. 2017 ; Vol. 86, No. 4. pp. 644-654.e2.
@article{f89eca505acf49e095714dfb352dbc8f,
title = "Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos)",
abstract = "Background and Aims EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. Methods Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95{\%} confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. Results A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95{\%}, 94{\%}, and 95{\%}, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95{\%} CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99{\%}, 98{\%}, and 98{\%}, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95{\%} CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively. Conclusions EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.)",
author = "Krishna, {Somashekar G.} and Brugge, {William R.} and Dewitt, {John M.} and Pradermchai Kongkam and Bertrand Napoleon and Carlos Robles-Medranda and Damien Tan and Samer El-Dika and Sean McCarthy and Jon Walker and Dillhoff, {Mary E.} and Andrei Manilchuk and Carl Schmidt and Benjamin Swanson and Shah, {Zarine K.} and Hart, {Phil A.} and Conwell, {Darwin L.}",
year = "2017",
month = "10",
doi = "10.1016/j.gie.2017.03.002",
language = "English (US)",
volume = "86",
pages = "644--654.e2",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions

T2 - an international external interobserver and intraobserver study (with videos)

AU - Krishna, Somashekar G.

AU - Brugge, William R.

AU - Dewitt, John M.

AU - Kongkam, Pradermchai

AU - Napoleon, Bertrand

AU - Robles-Medranda, Carlos

AU - Tan, Damien

AU - El-Dika, Samer

AU - McCarthy, Sean

AU - Walker, Jon

AU - Dillhoff, Mary E.

AU - Manilchuk, Andrei

AU - Schmidt, Carl

AU - Swanson, Benjamin

AU - Shah, Zarine K.

AU - Hart, Phil A.

AU - Conwell, Darwin L.

PY - 2017/10

Y1 - 2017/10

N2 - Background and Aims EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. Methods Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. Results A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively. Conclusions EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.)

AB - Background and Aims EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. Methods Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. Results A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively. Conclusions EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.)

UR - http://www.scopus.com/inward/record.url?scp=85018171197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018171197&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2017.03.002

DO - 10.1016/j.gie.2017.03.002

M3 - Article

C2 - 28286093

AN - SCOPUS:85018171197

VL - 86

SP - 644-654.e2

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -