Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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The role of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic neuroendocrine tumors

  • Masanori Yamada (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Kazuo Hara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nobumasa Mizuno (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Shin Haba (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Takamichi Kuwahara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nozomi Okuno (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Yasuhiro Kuraishi (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Takafumi Yanaidani (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Sho Ishikawa (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Tsukasa Yasuda (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Toshitaka Fukui (Department of Gastroenterology, Aichi Cancer Center Hospital)
  • Received : 2023.03.01
  • Accepted : 2023.04.19
  • Published : 2024.05.30
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Abstract

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs. Methods: This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies. Results: The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA. Conclusions: Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.

Keywords

Acknowledgement

The authors thank all patients who participated in this study and the investigators involved.

References

  1. Ishii T, Katanuma A, Toyonaga H, et al. Role of endoscopic ultrasound in the diagnosis of pancreatic neuroendocrine neoplasms. Diagnostics (Basel) 2021;11:316.
  2. Ito T, Hijioka S, Masui T, et al. Advances in the diagnosis and treatment of pancreatic neuroendocrine neoplasms in Japan. J Gastroenterol 2017;52:9-18. https://doi.org/10.1007/s00535-016-1250-9
  3. Krishna SG, Bhattacharya A, Li F, et al. Diagnostic differentiation of pancreatic neuroendocrine tumor from other neoplastic solid pancreatic lesions during endoscopic ultrasound-guided fine-needle aspiration. Pancreas 2016;45:394-400. https://doi.org/10.1097/MPA.0000000000000488
  4. Heidsma CM, Tsilimigras DI, Rocha F, et al. Clinical relevance of performing endoscopic ultrasound-guided fine-needle biopsy for pancreatic neuroendocrine tumors less than 2cm. J Surg Oncol 2020;122:1393-1400. https://doi.org/10.1002/jso.26158
  5. Hedenstrom P. The best approach for sampling of pancreatic neuroendocrine tumors: EUS-FNA or EUS-FNB? Endosc Int Open 2019;7:E1400-E1402. https://doi.org/10.1055/a-0959-6138
  6. Eusebi LH, Thorburn D, Toumpanakis C, et al. Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors. Endosc Int Open 2019;7:E1393-E1399. https://doi.org/10.1055/a-0967-4684
  7. Witt BL, Factor RE, Chadwick BE, et al. Evaluation of the SharkCore® needle for EUS-guided core biopsy of pancreatic neuroendocrine tumors. Endosc Ultrasound 2018;7:323-328. https://doi.org/10.4103/eus.eus_51_17
  8. Leeds JS, Nayar MK, Bekkali NL, et al. Endoscopic ultrasound-guided fine-needle biopsy is superior to fine-needle aspiration in assessing pancreatic neuroendocrine tumors. Endosc Int Open 2019;7:E1281-E1287. https://doi.org/10.1055/a-0990-9611
  9. Di Leo M, Poliani L, Rahal D, et al. Pancreatic neuroendocrine tumours: the role of endoscopic ultrasound biopsy in diagnosis and grading based on the WHO 2017 classification. Dig Dis 2019;37:325-333. https://doi.org/10.1159/000499172
  10. Kamata K, Ashida R, Yasukawa S, et al. Histological diagnosis and grading of pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle biopsy using a 25-gauge needle with a core trap: a multicenter prospective trial. Pancreatology 2020;20:1428-1433. https://doi.org/10.1016/j.pan.2020.08.023
  11. Hijioka S, Hara K, Mizuno N, et al. Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms. J Gastroenterol 2017;52:264.
  12. Konda VJ, Meining A, Jamil LH, et al. A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. Endoscopy 2013;45:1006-1013. https://doi.org/10.1055/s-0033-1344714
  13. Haba S, Yamao K, Bhatia V, et al. Diagnostic ability and factors affecting accuracy of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions: Japanese large single center experience. J Gastroenterol 2013;48:973-981. https://doi.org/10.1007/s00535-012-0695-8
  14. Kongkam P, Pittayanon R, Sampatanukul P, et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions (ENES): a pilot study. Endosc Int Open 2016;4:E17-E23. https://doi.org/10.1055/s-0034-1393183
  15. Giovannini M, Caillol F, Monges G, et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in solid pancreatic masses. Endoscopy 2016;48:892-898. https://doi.org/10.1055/s-0042-112573
  16. Karstensen JG, Cartana T, Constantinescu C, et al. Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses: a prospective validation study. Endosc Int Open 2018;6:E78-E85. https://doi.org/10.1055/s-0043-121987
  17. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-454. https://doi.org/10.1016/j.gie.2009.10.027
  18. McCall CM, Shi C, Klein AP, et al. Serotonin expression in pancreatic neuroendocrine tumors correlates with a trabecular histologic pattern and large duct involvement. Hum Pathol 2012;43:1169-1176. https://doi.org/10.1016/j.humpath.2011.09.014
  19. Nakai Y, Iwashita T, Park DH, et al. Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015;81:1204-1214. https://doi.org/10.1016/j.gie.2014.10.025
  20. Okuno N, Hara K, Obata M. Novel method of diagnosing solid pseudopapillary neoplasms of the pancreas: Needle-based confocal laser endomicroscopy. Dig Endosc 2019;31:461.
  21. Thoeni RF, Mueller-Lisse UG, Chan R, et al. Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity. Radiology 2000;214:483-490. https://doi.org/10.1148/radiology.214.2.r00fe32483
  22. Lewis RB, Lattin GE Jr, Paal E. Pancreatic endocrine tumors: radiologic-clinicopathologic correlation. Radiographics 2010;30:1445-1464. https://doi.org/10.1148/rg.306105523
  23. Krishna SG, Brugge WR, Dewitt JM, et al. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointest Endosc 2017;86:644-654. https://doi.org/10.1016/j.gie.2017.03.002
  24. Haq I, Krishna SG, Patel B, et al. The impact of repeating endosonography with confocal endomicroscopy for the diagnosis of cystic neuroendocrine tumor. Case Rep Gastrointest Med 2019;2019:5187874.
  25. Sharma P, Meining AR, Coron E, et al. Real-time increased detection of neoplastic tissue in Barrett's esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011;74:465-472. https://doi.org/10.1016/j.gie.2011.04.004
  26. Bertani H, Frazzoni M, Dabizzi E, et al. Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Dig Dis Sci 2013;58:188-193. https://doi.org/10.1007/s10620-012-2332-z
  27. Bok GH, Jeon SR, Cho JY, et al. The accuracy of probe-based confocal endomicroscopy versus conventional endoscopic biopsies for the diagnosis of superficial gastric neoplasia (with videos). Gastrointest Endosc 2013;77:899-908. https://doi.org/10.1016/j.gie.2013.01.018
  28. Lim LG, Yeoh KG, Srivastava S, et al. Comparison of probe-based confocal endomicroscopy with virtual chromoendoscopy and whitelight endoscopy for diagnosis of gastric intestinal metaplasia. Surg Endosc 2013;27:4649-4655.
  29. van den Broek FJ, van Es JA, van Eeden S, et al. Pilot study of probebased confocal laser endomicroscopy during colonoscopic surveillance of patients with longstanding ulcerative colitis. Endoscopy 2011;43:116-122. https://doi.org/10.1055/s-0030-1255954
  30. Rispo A, Castiglione F, Staibano S, et al. Diagnostic accuracy of confocal laser endomicroscopy in diagnosing dysplasia in patients affected by long-standing ulcerative colitis. World J Gastrointest Endosc 2012;4:414-420. https://doi.org/10.4253/wjge.v4.i9.414