Confocal Laser Endomicroscopy as an IMaging Biomarker for the Diagnosis of Pancreatic Cystic Lesions
Summary
The study schema is shown in Figure 4. (A) All patients referred to one of the participating academic centers for EUS evaluation of the PCL will be enrolled in the protocol if they satisfy inclusion criteria. Patient consent will be obtained during the clinic visit or prior to their EUS. EUS-guided nCLE imaging is first performed (B) followed by EUS-guided FNA and aspiration of cyst fluid. The cyst fluid is analyzed for CEA and cytology. As per institutional standard of care, the cyst fluid is also sent for molecular analysis. The results of the cyst fluid molecular analysis (B) will be utilized for the most likely diagnosis. Based on institutional multidisciplinary tumor board meetings, surgery is performed as indicated (C). Surgical histopathology serves as "gold standard" for diagnosis. It is anticipated that the majority of patients will undergo surgical resection after their EUS.
Outcome measures
Primary
Accuracy of PCL diagnosis
Diagnostic accuracy of confocal laser endomicroscopy and/or cyst fluid molecular markers and/or composite clinical and imaging features for the diagnosis of mucinous PCLs, PCLs with malignant potential, specific PCL types, and mucinous PCLs with advanced neoplasia.
Time frame: 48 months
Accuracy of risk-stratification of IPMNs
Diagnostic accuracy of confocal laser endomicroscopy and/or composite clinical and imaging features for the risk stratification of IPMNs
Time frame: 48 months
Secondary
Imaging quality
Time frame: 48 months
Eligibility criteria
Study locations (10)
Mayo Clinic Scottsdale Campus
Scottsdale, Arizona, 85259
Stanford Hospital
Stanford, California, 94305
Yale School of Medicine
New Haven, Connecticut, 06510
Parkview Hospital Randallia
Fort Wayne, Indiana, 46805
The Johns Hopkins Hospital
Baltimore, Maryland, 21287
Beth Israel Deaconess Medical Center
Boston, Massachusetts, 02215
NYU Langone Health
Garden City, New York, 11530
Icahn School of Medicine at Mount Sinai
New York, New York, 10029
The Ohio State University Wexner Medical Center
Columbus, Ohio, 43210
Baylor College of Medicine
Houston, Texas, 77030
References
- Firkins SA, Chen W, Krishna SG. Morphologic and Microscopic Characterization of an Unusual Pancreatic Cystic Lesion. Gastroenterology. 2021 May;160(6):e14-e16. doi: 10.1053/j.gastro.2020.09.046. Epub 2020 Oct 8. No abstract available.(PubMed)