Confocal endomicroscopy and cyst fluid molecular analysis: Comprehensive evaluation of pancreatic cysts

Table 1 Summary of major trials investigating role of endoscopic ultrasound guided needle based confocal laser endomicroscopy in the diagnosis of pancreatic cystic lesions

Study	Study outcome	Patients (n)	Surgery	Sensitivity	Specificity	Accuracy
Inspect[15]	Neoplastic cyst	66	14 (21.2%)	59	100	71
Detect[23]	Mucinous cyst	30	2 (6%)	80	100	89
Contact-1[19]	SCA	31	7 (22.5%)	69	100	87
Contact-2[17]	Mucinous cyst	33	9 (27.3%)	91	95	94
Index[24]	Mucinous cyst	30	22 (73.3%)	88	100	93

SCA: Serous cystadenoma.

Table 2 Summary of imaging (endoscopic ultrasound-needle-based confocal laser endomicroscopy) and molecular (cyst-fluid) biomarkers characteristic of different types of pancreatic cystic lesions

	IPMN	MCN	SCA	SPN	PC	NEN
Imaging biomarker
nCLE patterns	Finger-like Papillae[17,24]	Epithelial bands (single or multiple)[17]	Fern pattern or superficial vascular network[17,19]	Not well defined	Bright particles against dark background[17]	Trabecular pattern[17]
	Rope ladder or branched type vascularity[49]	Rope ladder or branched type vascularity[49]
Molecular biomarker
Cyst fluid molecular analysis	KRAS, GNAS, RNF43 positive[25,31,34]	KRAS, RNF43 positive, GNAS negative[25,31]	VHL positive[29]	CTNNB1 positive[25]	Negative	Not well characterized
Cysts with advanced neoplasia	TP53, SMAD4, PIK3CA, PTEN, CKDN2A positive[35,38,37]	TP53, SMAD4, PIK3CA, PTEN, CKDN2A positive[31]
	p16, p53 positive[37]

nCLE: Needle-based confocal laser endomicroscopy; IPMN: Intraductal papillary mucinous neoplasm; MCN: Mucinous cystic neoplasm; SCA: Serous cystadenoma; SPN: Solid pseudopapillary neoplasm; PC: Pseudocyst; NEN: Neuroendocrine neoplasm; Advanced neoplasia: Presence of high-grade dysplasia and/or adenocarcinoma.