Diagnostic accuracy of fluorescence confocal laser microscopy after EUS-TA

The results of a multicentre study suggest that fluorescence confocal laser microscopy (FCM) may be a useful tool for the real-time diagnosis of tissue from solid pancreatic lesions obtained via an endoscopic ultrasound procedure.

“Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is the current standard for the diagnosis of pancreatic solid lesions,” stated Dr Serena Stigliano (University of Rome, Italy) [1]. “However, endoscopic ultrasound sampling is associated with a risk of non-diagnostic or inconclusive results, with a negative predictive value around 70–80%.”

The multicentre study investigated the accuracy of FCM in diagnosing EUS-TA samples from pancreatic solid lesions and its agreement with the final histological diagnosis. “FCM is an optical imaging technique that provides digital microscopical images of fresh tissue in real-time,” clarified Dr Stigliano. The study included 80 participants with focal pancreatic solid lesions. After obtaining the samples, they were evaluated by FCM (VivaScope) and categorised as inadequate or adequate. The adequate samples were further classified as benign, suspicious, or malignant before undergoing standard histological evaluation.

A 22-gauge needle was used in 66.3% of the participants, while a 25-gauge needle was used in 32.5%. Dr Stigliano reported that 96.3% of the samples were categorised as adequate. The sensitivity of VivaScope was 97.3%, the specificity was 80%, and the overall accuracy was 96.3%. Overall, the concordance between the VivaScope diagnosis and the final histological diagnosis was moderate (Cohen's kappa coefficient 0.58). Needle type, size, and EUS technique were not associated with obtaining diagnostic samples.

Thus, FCM can quickly deliver information about sample adequacy and provide accurate diagnoses of EUS-TA with high accuracy. “It offers the opportunity of creating a digital image and a distant diagnosis, supporting remote consultations,” Dr Stigliano concluded.

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   1. Stigliano S, et al. Digital confocal microscopy for real-time diagnosis of pancreatic solid lesion: a multicentre study. LB17, UEG Week 2024, 12–15 October, Vienna, Austria.

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Posted on 28 November 2024