New digital confocal laser microscopy may boost real-time evaluation of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) from solid pancreatic lesions: Data from an international multicenter studyResearch in context
Isabel Amendoeira,
Paolo Giorgio Arcidiacono,
Jessica Barizzi,
Arrigo Capitanio,
Miriam Cuatrecasas,
Francesco Maria Di Matteo,
Claudio Doglioni,
Noriyoshi Fukushima,
Franco Fulciniti,
Angels Ginès,
Marc Giovannini,
Li Zaibo,
Joanne Lopes,
Giovanni Lujan,
Alice Parisi,
Flora Poizat,
Luca Reggiani Bonetti,
Serena Stigliano,
Chiara Taffon,
Martina Verri,
Anna Crescenzi
Affiliations
Isabel Amendoeira
Serviço de Anatomia Patológica, Centro Hospitalar Universitário de S. João (CHUSJ) and Ipatimup, Porto, Portugal
Paolo Giorgio Arcidiacono
Bilio-Pancreatic and Endosonography Unit, IRCCS Ospedale San Raffaele di Milano, Italy
Jessica Barizzi
Istituto Cantonale di Patologia, Locarno, Switzerland
Arrigo Capitanio
Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
Miriam Cuatrecasas
Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
Francesco Maria Di Matteo
Endoscopic Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Claudio Doglioni
Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
Noriyoshi Fukushima
Department of Pathology, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan
Franco Fulciniti
Istituto Cantonale di Patologia, Locarno, Switzerland
Angels Ginès
Endoscopy Unit. ICMDM, Hospital Clínic. Barcelona, Spain
Marc Giovannini
Chief of Gastroenterology Department at Paoli-Calmettes Institute, France
Li Zaibo
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
Joanne Lopes
Serviço de Anatomia Patológica, Centro Hospitalar Universitário de S. João (CHUSJ) and Ipatimup, Porto, Portugal
Giovanni Lujan
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
Alice Parisi
Department of Pathology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona Italy
Flora Poizat
Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
Luca Reggiani Bonetti
Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
Serena Stigliano
Endoscopic Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Chiara Taffon
Unit of Pathology of Endocrine Organs and Neuro-muscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Martina Verri
Unit of Pathology of Endocrine Organs and Neuro-muscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Anna Crescenzi
Unit of Pathology of Endocrine Organs and Neuro-muscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Corresponding author. Unit of Pathology of endocrine organs and neuro-muscular pathology, Fondazione Policlinico Universitario Campus Bio-Medico. Via Alvaro del Portillo, 200 00128, Rome, Italy.
Summary: Background: Pancreatic cancer is an aggressive malignancy and a leading cause of cancer death worldwide; its lethality is partly linked to the difficulty of early diagnosis. Modern devices for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) were recently developed to improve targeting and sampling of small lesions, but innovative technologies for microscopic assessment are still lacking. Ex vivo fluorescence confocal laser microscopy (FCM) is a new digital tool for real-time microscopic assessment of fresh unfixed biological specimens, avoiding conventional histological slide preparation and potentially being highly appealing for EUS-FNB specimens. Methods: This study evaluated the possible role of FCM for immediate evaluation of pancreatic specimens from EUS-FNB. It involved comparison of the interobserver agreement between the new method and standard histological analysis during international multicenter sharing of digital images. Digital images from 25 cases of EUS-FNB obtained with real-time FCM technology and 25 paired digital whole-slide images from permanent conventional paraffin sections were observed by 10 pathologists from different Institutions in Europe, Japan, and the United States, in a blinded manner. The study evaluated 500 observations regarding adequacy, morphological clues, diagnostic categories, and final diagnosis. Findings: Statistical analysis showed substantial equivalence in the interobserver agreement among pathologists using the two techniques. There was also good inter-test agreement in determining sample adequacy and when assigning a diagnostic category. Among morphological features, nuclear enlargement was the most reproducible clue, with very good inter-test agreement. Interpretation: Findings in this study are from international multicenter digital sharing and are published here for the first time. Considering the advantages of FCM digital diagnostics in terms of reduced time and unaltered sample maintenance, the ex vivo confocal laser microscopy may effectively improve traditional EUS-FNB diagnostics, with significant implications for planning modern diagnostic workflow for pancreatic tumors. Funding: This study was not supported by any funding source.
