The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review
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The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominalimaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs thatrequire surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriatelyaggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopicexamination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE andhistological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed thehigh diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown toimprove the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity andmortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes forpancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate managementhave resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantlyimproved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of thepancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.
Abstract
The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominalimaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs thatrequire surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriatelyaggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopicexamination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE andhistological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed thehigh diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown toimprove the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity andmortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes forpancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate managementhave resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantlyimproved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of thepancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.
참고문헌 (33)
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