Abstract
We demonstrate for the first time that optical coherence tomography (OCT) imaging can reliably distinguish between morphologic features of low risk pancreatic cysts (i.e., pseudocysts and serous cystadenomas) and high risk pancreatic cysts (i.e., mucinous cystic neoplasms and intraductal papillary mucinous neoplasms). In our study fresh pancreatectomy specimens (66) from patients with cystic lesions undergoing surgery were acquired and examined with OCT. A training set of 20 pathology-OCT correlated tissue specimens were used to develop criteria for differentiating between low and high risk cystic lesions. A separate (validation) set of 46 specimens were used to test the OCT criteria by three clinicians, blinded to histopathology findings. Histology was finally used as a ‘gold’ standard for testing OCT findings. OCT was able to reveal specific morphologic features of pancreatic cysts and thus to differentiate between low-risk and high-risk cysts with over 95% sensitivity and specificity. This pilot study suggests that OCT could be used by clinicians in the future to more reliably differentiate between benign and potentially malignant pancreatic cysts. However, in vivo use of OCT requires a probe that has to fit the bore of the pancreas biopsy needle. Therefore, we have developed such probes and planned to start an in vivo pilot study within the very near future.
Highlights
Pancreatic cystic lesions represent an increasingly common diagnostic and therapeutic challenge [1]
This paper presents the results of a pilot study that had the goal to investigate the possibility of using optical coherence tomography (OCT) imaging for differentiating between morphologic features of low risk pancreatic cysts and high risk pancreatic cysts (i.e., MCNs and IPMNs)
Focal intraluminal scattering was noted on OCT (Fig. 2(B)), and this corresponded to a focus of fresh intraluminal hemorrhage shown in the histological appearance (Fig. 2(B′))
Summary
Pancreatic cystic lesions represent an increasingly common diagnostic and therapeutic challenge [1]. A significant number of pancreatic cysts are detected incidentally when noninvasive abdominal imaging is performed for unrelated diagnosis [2]. The differentiation between low- and high-risk lesions is difficult with traditional imaging [3]. Low-risk lesions (simple cysts, pseudocysts, and serous cystadenomas [SCAs]) are generally not resected because they have no risk or an extremely low risk of malignant transformation [4]. High-risk lesions are mucin-producing tumors (mucinous cystic neoplasms [MCNs] and intraductal papillary mucinous neoplasms [IPMNs]) and cystic solid tumors (papillary cystic tumors, cystic ductal adenocarcinoma, and islet cell tumor) [5]. Depending on degree of dysplasia [6], MCNs and IPMNs are classified as adenoma, borderline, carcinoma in situ, or invasive cancer
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