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, acquired through an endoscopic ultrasound procedure.

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

The current, multicentre study investigated the accuracy of FCM in predicting the diagnosis of EUS-TA samples of pancreatic solid lesions and its agreement with the final histological diagnosis. “FCM is an optical imaging technique to provide digital microscopical images of fresh tissue in real-time,” clarified Dr Stigliano.  Included were 80 participants with focal pancreatic solid lesions. After the samples were obtained, they were evaluated by FCM (VivaScope) and categorised as ‘inadequate’ or ‘adequate’. “The ‘adequate’ samples were further classified as benign, suspicious, or malignant. Subsequently, the samples underwent the standard histological evaluation.

A 22-gauge needle was used with 66.3% of the participants, and a 25-gauge needle with 32.5% of participants. Dr Stigliano said 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%. Furthermore, the concordance between the VivaScope diagnosis and the final histological diagnosis was moderate (kappa Cohen’s coefficient 0.58). There was no association between the type and size of needles, or EUS technique with diagnostic sample obtainment.

Thus, FCM can quickly deliver information about sample adequacy and diagnosis of EUS-TA with high accuracy. “It offers the opportunity of creating a digital image and a ‘distant diagnosis’ to be used for remote consulting,” Dr Stigliano concluded.

1. 
   
   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.

Medical writing support was provided by Robert van den Heuvel.
Copyright ©2024 Medicom Medical Publishers



Posted on 17 October 2024