Needle-based Confocal Laser Endomicroscopy Research Articles

Use of needle-based confocal laser endomicroscopy in the diagnosis and management of pancreatic cyst lesions.

Use of needle-based confocal laser endomicroscopy in the diagnosis and management of pancreatic cyst lesions.

A health economic evaluation of needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cysts.

Background and study aims The low sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), especially for the diagnosis of serous cystadenomas (SCAs), can be associated with diagnostic uncertainty that can regularly lead to unnecessary surgical procedures. Needle-based confocal laser endomicroscopy (nCLE) used with EUS-FNA improves diagnostic accuracy, helping to reduce unnecessary surgery and patient follow-up. This study was conducted to evaluate the economic benefit of EUS-FNA + nCLE. Patients and methods Probabilities used were derived from two studies representative of the two diagnostic strategies: a retrospective analysis of patients diagnosed by EUS-FNA alone and a prospective study of patients diagnosed by EUS-FNA + nCLE. Costs were based on French healthcare system rates; both private and public sector rates were included. A decision tree structure model used these probabilities and costs for two hypothetical cohorts of 1000 patients. Results EUS-FNA + nCLE resulted in a reduction of 23 % in the total rate of surgical intervention, which translated to a reduction in clinical costs of 13 % (public sector) and 14 % (private sector). Additionally, the reduced rate of surgery would save the lives of 4 in 1000 patients. A stochastic sensitivity analysis using 100 simulations showed that in all cases the number of interventions was less for EUS-FNA + nCLE than for EUS-FNA. There was also a reduction in the incidence of false negatives using EUS-FNA + nCLE. Conclusions EUS-FNA + nCLE results in significant economic benefits by reducing the incidence of misdiagnosis through improved diagnostic accuracy.

The clinical evaluation of needle-based confocal laser endomicroscopy in the assessment of pancreatic cystic lesion: A pilot study

Background/aim: Pancreatic cystic lesions are increasingly diagnosed from cross-sectional imaging done for other indications. The challenge lies in the ability to correctly identify the high-risk individuals for resection surgery, which carries high morbidity and mortality. Unfortunately, present diagnostic techniques are suboptimal. Needle-based confocal laser endomicroscopy (nCLE) has been designed to bridge this diagnostic gap. We aim to assess the feasibility and safety of nCLE in the assessment of pancreatic cystic lesions. Methods: We prospectively recruited patients referred for assessment of pancreatic cystic lesions from August 2014 until July 2015. All pancreatic cystic lesions were examined with nCLE miniprobe via endoscopic ultrasound followed by fine-needle aspiration. Information regarding the cysts (morphology, location, fluid analysis etc.) was documented. Adverse event was recorded. Results: Fourteen patients were recruited, six were male with a mean age of 66.5 (range 48–80) years. Only 12 completed nCLE examination of the pancreatic cystic lesions. nCLE imaging was successful in 83.3% (10/12). Average nCLE imaging duration was 5 min 18 s. There was one (10%) adverse event. nCLE impressions were correct in eight cases (five malignant and three benign) compared with final diagnosis. Three patients underwent surgery, histology showed ductal adenocarcinoma, pancreatic neuroendocrine tumor and gastric-subtype of intraductal papillary mucinous neoplasm. The sensitivity and specificity of the nCLE impression when compared with final diagnosis were 83.3% and 75% respectively. The accuracy of nCLE was 80%. Conclusion: Our results have demonstrated that nCLE assessment of pancreatic cystic lesions is safe and feasible. It may complement the existing diagnostic modalities to improve diagnostic yield.

EUS-guided needle-based confocal laser endomicroscopy (nCLE) findings in cystic lesions of the pancreas (CLP)

EUS-guided needle-based confocal laser endomicroscopy (nCLE) findings in cystic lesions of the pancreas (CLP)

Needle-based confocal laser endomicroscopy in the diagnosis of peripheral pulmonary nodule: a preliminary report.

Lung cancer is one of the most fatal cancers in the world. To early distinguish benign and malignant pulmonary nodule is critical for disease prognosis. Confocal laser endomicroscopy (CLE) can be used to explore bronchus mucous membrane, alveolar elastic fiber structures and microvessels, and could be helpful for the diagnostic imaging and for the localization guidance. In this report, we presented two cases of peripheral pulmonary nodule. Under the guidance of X-ray and endobronchial ultrasound, needle-based confocal laser endomicroscopy (nCLE) could directly approach the peripheral pulmonary nodule via an exploratory puncture needle. The results indicated that the utility of the nCLE is helpful to precise positioning and characterize the peripheral pulmonary nodule. This report presents for the first time the application of nCLE for positioning the peripheral extraluminal nodule and describe the different confocal imaging features between adenocarcinoma and tuberculosis.

Endoscopic ultrasonography evaluation for pancreatic cysts: Necessity or overkill?

Incidental pancreatic cysts have become gradually more recognized in clinical practice as a result of increased use of transabdominal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). These lesions consist of inflammatory cysts (pseudocysts) and pancreatic cystic neoplasms (PCN) which have been classified as benign, premalignant and malignant. The diagnosis and management strategy of incidentally discovered pancreatic cysts can be challenging as the majority of them are PCN and CT or MRI alone may not be sufficient to provide an accurate diagnosis. Endoscopic ultrasound (EUS)-guided fine-needle aspiration provides a method to obtain cyst fluid for analysis and the recently developed EUS-based technology including contrast-enhanced ultrasound, cystoscopy and needle-based confocal laser endomicroscopy allows endosonographers to gain additional useful information. The current data suggest that EUS evaluation of pancreatic cysts offers some benefits especially in cases of inconclusive CT or MRI.

602 - Needle-Based Confocal Laser Endomicroscopy (nCLE) for the Diagnosis of Pancreatic Cystic Lesions: Preliminary Results of the First Prospective Multicenter Study

602 - Needle-Based Confocal Laser Endomicroscopy (nCLE) for the Diagnosis of Pancreatic Cystic Lesions: Preliminary Results of the First Prospective Multicenter Study

Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos)

EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis. Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n= 23) or clinical (n= 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used. A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ= 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ= 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ= 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ= 0.85 ± 0.11 (almost perfect), respectively. EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.).

Needle-Based Confocal Laser Endomicroscopy for Evaluation of Cystic Neoplasms of the Pancreas.

The accurate diagnosis of cystic neoplasms of the pancreas (CNP) with current diagnostic methods is limited. Endoscopic ultrasound (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) is a new technique which can obtain images from the cyst wall during EUS-fine needle aspiration (EUS-FNA). The aim of this study was to assess the safety, feasibility, and diagnostic value of nCLE for CNP. Patients who underwent EUS-FNA to evaluate a CNP larger than 2cm were enrolled. The cyst was punctured with 19-G FNA needle preloaded with an nCLE probe. The images from different areas of the cyst wall were recorded. Using the final diagnosis defined by surgery or EUS-FNA cyst fluid analysis, the accuracy of the confocal images was defined. The procedure and image acquisition was successful in 18 of the 20 patients. Predefined typical structures for mucinous cysts were visualized in 8 of 12 (66%) cysts but none of the non-mucinous cysts. The superficial vascular network which is a typical finding of serous cysts was observed in 2 of 3 patients. The sensitivity, specificity, and diagnostic accuracy of the findings of epithelial structures by nCLE were 66, 100, and 80%, respectively, for a mucinous cyst diagnosis. All patients tolerated the procedure well, and no adverse effects were determined. nCLE was found to be safe and feasible with high technical success, in this pilot study. With an overall accuracy of 80%, it has the potential to contribute to the diagnosis of CNP with specific imaging.

Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: An international external inter- and intra-observer study

Background and Objectives:Endoscopic ultrasonography (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) although identified lacks external validation and surgical histopathology was available in a minority of subjects. We sought to externally validate EUS-nCLE images for differentiating PCLs in a larger series of subjects with a definitive diagnosis.Methods:Six expert endosonographers, blinded to clinical data, reviewed nCLE images of PCLs from 29 subjects with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. The performance characteristics of nCLE and the kappa-statistic for interobserver agreement (IOA, 95% confidence interval [CI]) and intraobserver reliability (IOR, mean, standard deviation [SD]) for the identification of nCLE image patterns were calculated. Landis and Koch interpretation of kappa values was used.Results:A total of 29 (16 mucinous PCLs, 13 nonmucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean, SD) were κ = 0.81 (almost-perfect), 95% CI 0.71–0.90 and κ = 0.86, 0.11 (almost-perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas were 99%, 98%, and 98%, respectively. The IOA and IOR (mean, SD) for recognizing characteristic image pattern of serous cystadenomas were κ = 0.83 (almost-perfect), 95% CI 0.73–0.92 and κ = 0.85, 0.11 (almost-perfect), respectively.Conclusion:EUS-nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intra-observer agreement in differentiating mucinous versus nonmucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS-nCLE.

Is the Stella™ 5L system an effective cold sterilization technique for needle-based confocal miniprobes?

Background and Objective:Needle-based confocal laser endomicroscopy (nCLE) under endoscopic ultrasound guidance is a newly developed imaging technique for pancreatic lesions and lymph nodes, enabling a subcellular level of resolution. The confocal miniprobe is an invasive instrument designed to be reused up to 10 times. Therefore, a method that ensures the complete elimination of microbial contaminants on the device is necessary. We studied the bactericidal efficacy of the Stella™ system, which purports to achieve this objective.Materials and Methods:The surfaces of three nCLE miniprobes were contaminated with suspensions of Bacillus atrophaeus (ATCC9372). One probe was randomly selected to count the bacterial load on the surface. The other two probes were manually cleaned and rinsed. One probe was randomly selected to count bacteria on the surface, and the other probe was sterilized using the Stella™ 5L endoscopic sterilization system before obtaining the bacterial count. The process was repeated for 20 cycles to evaluate the microbicidal efficacy of the Stella™ 5L endoscopic sterilization system. These miniprobes were immersed in the Stella Fuse disinfectant for 72 h. After the 72 h of immersion, the weight loss of probes was determined using a high precision electronic scale to examine corrosion following disinfection. The change in image quality was evaluated by an endoscopist.Results:From an initial contamination level of 4.48 × 106 ± 1.57 × 106 cfu/mL on the surface of the probes, the bacterial count was reduced to 4.25 × 102 ± 1.95 × 102 cfu/mL after manual cleaning (including enzyme washing), and no microorganisms were recovered after 20 cycles with the Stella™ 5L system. The probe weights before and after 72 h of immersion were 45.769 (45.768–45.771) g and 45.762 (45.752–45.768) g, respectively. No change in image quality was observed.Conclusion:This study shows that the Stella™ 5L system is capable of the complete elimination of microorganism contamination in a short period and avoids the toxicity of typical disinfectants. It is a safe, cheap, and efficient sterilization approach that provides a new option for nCLE miniprobe sterilization.

Endoscopic ultrasonography-guided needle-based confocal laser endomicroscopy has improved accuracy compared to the current standard of care for differentiating mucinous from nonmucinous pancreatic cystic lesions

Background and Objectives:Endoscopic ultrasonography (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) patterns for diagnosing mucinous pancreatic cystic lesions (PCLs) have been recently validated. The aim of this study was to compare the accuracy of EUS-nCLE to the standard of care for differentiating mucinous from nonmucinous PCLs.Methods:In a prospective study evaluating EUS-nCLE, fluid from 59 PCLs was analyzed by carcinoembryonic antigen (CEA), cytology, and next generation sequencing (NGS). The final diagnosis of PCLs was based on surgical histopathology (n = 36 [61%]) or clinical diagnosis based on imaging features, specific NGS results, follow-up >1 year, and/or resolution of PCL (n = 23 [39%]). Diagnostic indices and area under receiver operator curve (ROC) of different modalities were computed for all subjects.Results:Among the 59 subjects (31 females; mean age 59.4 years), 36 cysts were mucinous and 23 nonmucinous. The ROC analyses associated with the detection of patterns of “epithelial bands/papillae” for mucinous PCLs demonstrated the greatest area under the curve (96%). The sensitivity, specificity, and accuracy of nCLE were significantly greater than the accuracy of CEA, cytology, and combination of CEA/cytology (P < 0.001). When the study population was restricted to those with surgical histopathology (n = 36; mucinous 26 [72%]), diagnostic accuracy of nCLE for mucinous PCLs continued to be higher than the combination of CEA/cytology (94% vs. 67%, P = 0.006).Conclusions:Among the current diagnostic modalities, EUS-nCLE detection of “epithelial bands or papillae” is more accurate than the current “standard of care” for the differentiation of mucinous from nonmucinous PCLs. These preliminary results warrant further validation in larger, multicenter studies.

Can endoscopic ultrasound-guided needle-based confocal laser endomicroscopy replace fine-needle aspiration for pancreatic and mediastinal diseases?

New applications of confocal laser endomicroscopy (CLE) have been developed, such as needle-based CLE (nCLE) for pancreatic masses, pancreatic cystic tumors, and lymph nodes. nCLE is feasible during endoscopic ultrasound (EUS) examination, and preliminary results are very encouraging and suggest this technology may be used in future as a useful adjunct in cases of inconclusive EUS-guided fine-needle aspiration. The aim of this paper is to give an update in this new technology and to define its place in the diagnosis of pancreatic masses and mediastinal diseases.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in pancreatic neoplasms: A single-center experience in China

Objective:The objective of the study is to investigate the application of endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (EUS-nCLE) in the diagnosis of pancreatic neoplasms.Methods:Patients with pancreatic neoplasms were diagnosed by endoscopic ultrasound and punctured by 19G needle; Cellvizio AQ-Flex19 confocal microprobe was implanted through the needle. The diagnostic yield and complication were evaluated and compared with pathology.Results:A total of 28 patients successfully underwent EUS-nCLE examination, including serous cystadenoma (n = 5), mucinous cystadenoma (n = 3), intraductal papillary mucinous neoplasms (n = 3), pseudocyst (n = 1), ductal adenocarcinoma (n = 10), neuroendocrine tumors (1), solid pseudopapillary tumor (n = 2), chronic pancreatitis (n = 2), and lymphoma (n = 1). High-quality images were obtained in all the patients. The diagnostic yield in 26 patients with pathology was 73.1% (19/26) and the specificity of serous cystic neoplasm (SCN) and intraductal papillary mucinous neoplasm (IPMN) was 100% (7/7). The complications, mostly pancreatitis and intracystic hemorrhage, were occurred in 10.7% (3/28) patients.Conclusion:EUS-nCLE is a safe and feasible method in the diagnosis of pancreatic neoplasms and shows high specificity in SCN and IPMN.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions

Needle-Based Confocal Laser Endomicroscopy-Assisted Diagnosis of Acinar Cell Cystadenocarcinoma of the Pancreas

Acinar cell carcinoma of the pancreas is a vey rare pancreatic neoplasm. It represents 1-2% of all pancreatic exocrine malignant tumors. We present this rare case of a 79-year-old female with an incidental findings of a pancreatic cyst. The diagnosis of Acinar cell cystadenocarcinoma, a rare variant of acinar cell carcinoma, was made utilizing endoscopic ultrasound with fine needle aspiration (EUS-FNA) with needle based confocal laser endomicroscopy (NCLE). A 79-year-old white female with a past medical history of hypertension, who had multiple admissions to the hospital due to recurrent diverticulitis attacks. CT abdomen and pelvis with contrast showed evidence of diverticulitis with an abscess formation and an incidental findings of a pancreatic cyst. She underwent an EUS that showed a 13 mm by 19 mm cyst in the body of the pancreas. There was a single compartment, thin outer wall and a mural nodule was seen. Needle based confocal laser endomicroscopy (NCLE) was utilized showing atypical cells suggestive of an intraductal papillary mucinous neoplasm. Fine needle aspiration was performed; two passes were made with a 19 gauge needle using a transgastric approach. The pancreatic duct was normal appearance in the entire pancreas. There was no signs of significant pathology in the liver, biliary system, gallbladder, or the ampulla. Further pathology evaluation showed cells were positive for trypsin, and chymotrypsin, and immunohistochemical stain were suggestive of an acinar cystadenocarcinoma, a rare variant of acinar cell carcinoma. Surgical intervention was sought by the patient. Whipple's procedure was intended but due to the extent of the lesion and encasement of surrounding vasculature, curative surgery was not possible. Therefor a biopsy was taken which confirmed the diagnosis and the patient was referred for chemotherapy. Acinar cell cystadenocarcinomas are rare, grossly cystic neoplasms with cytoarchitectural features of acinar cell carcinomas. These lesions are generally slow-growing, and do not cause any significant symptoms. However, as the lesions increase in size they can cause abdominal pain, nausea, vomiting, as well as weight loss. In this case we present an additional modality that assists in the diagnosis and differentiation of the type of pancreatic cysts. NCLE, allows microscopic tissue information in real-time in vivo during EUS-FNA, helping in the differentiation of malignant tumor from normal pancreatic tissue.Figure 1

Cystic Pancreatic Neuroendocrine Tumors: Validation of In Vivo Needle-Based Confocal Laser Endomicroscopy Findings by Ex Vivo Analysis

Cystic Pancreatic Neuroendocrine Tumors: Validation of In Vivo Needle-Based Confocal Laser Endomicroscopy Findings by Ex Vivo Analysis

A Primary Keratinizing Squamous Cell Carcinoma of the Pancreas: Endosonography and Confocal Endomicroscopy of an Unusual Pancreatic Cystic Lesion

Case Report: A 79-year-old woman presented with abdominal discomfort and unintentional weight loss. A computed tomography scan demonstrated a 7 cm complex pancreatic cystic lesion (PCL) along with multiple hepatic cystic lesions. Endoscopic ultrasound (EUS) demonstrated a 7.1 x 6.7 cm anechoic cystic lesion with an irregularly thick wall and multiple mural nodules in the pancreatic body without obvious communication with the main pancreatic duct. On protocol, EUS-guided needle-based confocal laser endomicroscopy (nCLE) with an AQ-Flex 19 miniprobe (Cellvizio, Mauna Kea Technologies, Paris, France) revealed large cells of unequal shapes and sizes (> 20 μ) suggestive of a malignant process. Fine needle aspiration (FNA) confirmed a diagnosis of pancreatic keratinizing squamous cell carcinoma (SCC) metastatic to liver with demonstration of irregular spindle-like cells, hyperchromatic cells, and dense keratin material from both the primary pancreatic and metastatic liver lesions. Discussion: A primary pancreatic SCC constitutes a rare diagnosis with very few reports described in the literature. One large case series reviewed 5075 patients and reported the incidence of pure squamous cell carcinoma 0.5% of the total pancreatic ductal carcinomas1. Moreover, this case is unique for being an unusual presentation of a PCL where the diagnosis of malignancy was suspected by EUS-nCLE and confirmed with FNA. This adds to the growing literature of intracystic nCLE image patterns in the diagnosis of PCLs. 1) Baylor SM, Berg JW. Cross-classification and survival characteristics of 5,000 cases of cancer of the pancreas. J Surg Oncol 1973;5:335-358.

Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions.

Background and aims: Endoscopic ultrasound (EUS)-guided needle-based Confocal Laser Endomicroscopy (nCLE) characteristics of pancreatic cystic lesions (PCLs) have been identified in studies where the gold standard surgical histopathology was available in a minority of patients. There are diverging reports of interobserver agreement (IOA) and paucity of intraobserver reliability (IOR). Thus, we sought to validate current EUS-nCLE criteria of PCLs in a larger consecutive series of surgical patients. Methods: A retrospective analysis of patients who underwent EUS-nCLE at a single center was performed. For calculation of IOA (Fleiss’ kappa) and IOR (Cohen’s kappa), blinded nCLE-naïve observers (n = 6) reviewed nCLE videos of PCLs in two phases separated by a 2-week washout period. Results: EUS-nCLE was performed in 49 subjects, and a definitive diagnosis was available in 26 patients. The overall sensitivity, specificity, and accuracy for diagnosing a mucinous PCL were 94 %, 82 %, and 89 %, respectively. The IOA for differentiating mucinous vs. non-mucinous PCL was “substantial” (κ = 0.67, 95 %CI 0.57, 0.77). The mean (± standard deviation) IOR was “substantial” (κ = 0.78 ± 0.13) for diagnosing mucinous PCLs. Both the IOAs and mean IORs were “substantial” for detection of known nCLE image patterns of papillae/epithelial bands of mucinous PCLs (IOA κ = 0.63; IOR κ = 0.76 ± 0.11), bright particles on a dark background of pseudocysts (IOA κ = 0.71; IOR κ = 0.78 ± 0.12), and fern-pattern or superficial vascular network of serous cystadenomas (IOA κ = 0.62; IOR κ = 0.68 ± 0.20). Three (6.1 % of 49) patients developed post-fine needle aspiration (FNA) pancreatitis. Conclusion: Characteristic EUS-nCLE patterns can be consistently identified and improve the diagnostic accuracy of PCLs. These results support further investigations to optimize EUS-nCLE while minimizing adverse events.Study registration: NCT02516488

Últimos avances sobre los tumores pancreáticos

Pancreatic cancer continues to have a bleak prognosis. Hardly any therapeutic advances have been made in the last few years and consequently most efforts have focused on preventing its development and on diagnosing precursor lesions. In this regard, the use of statins as a preventive factor and the implementation of screening programmes in high-risk patients are gaining ground. In the field of treatment, there is greater focus on the role of neoadjuvant therapy in pancreatic cancer and on a multimodal approach to the disease, with few advances in effective novel therapies. Most studies concerned cystic tumours of the pancreas, especially intraductal mucinous papillary tumour, with its known potential for malignant transformation. Multiple studies were devoted to validation of the 2012 Fukuoka international guidelines and the highly controversial 2015 AGA guidelines. Notable among these studies were those demonstrating the suboptimal positive predictive value and questioning important aspects of the guidelines, such as discontinuation of follow-up or the criteria for surgical referral. Notable among diagnostic procedures were cystoscopy and endoscopic ultrasound-guided needle-based confocal laser endomicroscopy as the most promising techniques due to their high efficacy and negative predictive value in detecting mucinous cystic lesions. There were also a large number of studies on the natural history of intraductal papillary mucinous tumours, which help deepen knowledge of these entities and the search for predictive factors of cancer development.