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Impact of the use of endoscopic ultrasound-guided biopsy micropipes





Impact of EUS-guided microforceps biopsy and needle-based confocal laser endomicroscopy on the diagnostic yield and clinical management of pancreatic cystic lesions.


(Impacto del uso de micropinzas de biopsias guiadas por ultrasonido endoscópico y endomicroscopia confocal a través de aguja de punción en el rendimiento diagnóstico y manejo clínico de lesiones quísticas pancreáticas)


DOI: https://doi.org/10.1016/j.gie.2019.12.022

Antonio R. Cheesman, MD, Hongfa Zhu, MD, PhD, Xiaoyan Liao, MD, PhD, Arnold H. Szporn, MD, Nikhil A. Kumta, MD, MS, Satish Nagula, MD, Christopher J. DiMaio, MD Gastrointest Endosc. 2020 May;91(5):1095-1104. doi: 10.1016/j.gie.2019.12.022. Epub 2019 Dec 25

Certain types of LQPs are at risk of malignancy, hence the importance of arriving at a concrete diagnosis to determine follow-up or surgical treatment.


For this reason, several studies have been conducted that include new technologies aimed at increasing the accuracy of the diagnosis of these lesions, such as: microbiopsies directed by echoendoscopy (MFB) for direct biopsies of the cyst wall and confocal endomicroscopy of the cyst wall (nCLE) that allows real-time analysis of the epithelial pattern and vascularity of the cyst wall.


Antonio R. Cheesman and collaborators conducted a single-center retrospective study in patients with LQP who combined EUS-guided FNA, MFB, and nCLE. The primary objective was to determine the diagnostic performance (specific cyst type) and change in clinical management for each modality compared to the "standard system" (SE) of diagnosis obtained by the combination of clinical history, morphology, cytology, and chemical analysis of the cyst.


A total of 44 patients with 44 cysts were included. The technical success was: EUS-FNA 100%, MFB 88.6%, nCLE 97.7%. Adverse events: 1 of 44 (2.3%, an infected pseudocyst). Diagnostic performance for each modality: SE 34.1%, MFB 75.0% (p<0.05 vs CS), nCLE, 84.1% (p<0.05 vs CS). Diagnostic performance of combined tests: SE/MFB 79.5%, SE/nCLE, 88.6%, SE/MFB/nCLE, 93.2% (p=NS). Compared with the SE, the use of MFB, nCLE, and their combination, led to an overall change in clinical management in 38.6%, 43.2%, and 52.3% of cases. MFB and nCLE led to increased discontinuation of follow-up (MFB 34.1% p<0.05, nCLE 31.8%, p<0.05). Additionally, based on MFB and nCLE, 2 of 28 (7.1%) and 3 of 28 (10.7%) patients who would have been subject to surveillance were referred to surgery.


Comment:

The data presented in this study show that the use of new technologies is technically reproducible, safe and offer a change in the follow-up and definitive treatment of these injuries", Raquel Del Valle, MD- IECED specialist.

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