Needle confocal laser endomicroscopy in the diff erential diagnosis of pancreatic cystic lesions

Czech version

Authors: Rudolf Repák ¹; Tomáš Fejfar ¹; Miroslav Podhola ²; Aleš Ryška ²; Ilja Tachecí ¹
Published in: Gastroent Hepatol 2024; 78(4): 291-298
Category: Clinical and Experimental Gastroenterology: Review Article
doi: https://doi.org/10.48095/ccgh2024291

Overview

Background: Pancreatic cystic lesions are relatively common findings, and their prevalence continues to rise, which is also related to the expansion of imaging methods. Up to 15% of pancreatic cancers arise from mucinous cystic tumours of the pancreas, primarily from intraductal papillary mucinous neoplasia (IPMN). Needle-based confocal laser endomicroscopy (nCLE) represents an advanced diagnostic method with the potential to improve the accuracy of diagnosing focal pancreatic lesions. Aim: The aim of the work is to provide a recent overview of the position of nCLE in the diagnosis of pancreatic cystic lesions and some of our own experiences. The nCLE method is based on so-called real-time optical biopsy, which brings better diagnostic results compared to traditional methods such as CT, MRI/MRCP, and EUS, as confirmed by the authors‘ own data. Although nCLE offers certain advantages, its wider use in clinical practice is limited by the high costs of equipment, technical difficulties during examination, and the need for thorough training of endoscopists. The integration of all diagnostic procedures (EUS, cytology, nCLE, and next-generation sequencing) into artificial intelligence algorithms could minimize the disadvantages of individual methods and increase the overall efficiency of diagnosing pancreatic cystic lesions. Conclusion: nCLE represents an innovative method for diagnosing pancreatic cystic lesions, which, in combination with other procedures (microforceps biopsy, next-generation sequencing, assessment of nCLE findings, and overall malignancy risk using artificial intelligence), can further enhance its diagnostic accuracy in this context.

Keywords:

needle-based confocal laser endomicroscopy – pancreatic cystic lesion – optical biopsy – endoscopic ultrasound – artificial intelligence

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ORCID autorů

R. Repák 0000-0002-8288-2646,

T. Fejfar 0000-0002-4126-4067,

M. Podhola 0000-0002-1047-8062,

A. Ryška 0000-0002-3051-2280,

I. Tachecí 0000-0003-3583-2651.

Doručeno/Submitted: 31. 7. 2024

Přijato/Accepted: 6. 8. 2024

Korespondenční autor

MUDr. Rudolf Repák

II. interní gastroenterologická klinika

LF UK a FN Hradec Králové