胰腺囊腫答案在囊壁上

細(xì)針型激光共聚焦顯微內(nèi)鏡nCLE)改善患者護(hù)理，避免不必要的檢查和治nCLEnCLE Cellvizio突破性影像科組織表面實(shí)時(shí)成性顯微成像放大1000即時(shí)信微與所有內(nèi)鏡匹SIMPLEFACTS:PANCREATICCYSTSAREINCREASINGLYFOUND60年來 病率從3%增至10%在大型醫(yī)療中心至少的住院患者患有胰腺囊腫2-?SIMPLEFACTS:但60%?80%Only僅有非常小的一部分胰腺囊腫會(huì)

非 變 57%患有良性囊腫的患者接受了手““臨床醫(yī)生面對(duì)的是一群需要監(jiān)督隨訪或手術(shù)的患者，他們需要從中及早鑒別出少數(shù)并避免對(duì)良性囊腫患者做不必要的手術(shù)治療病患Allenetal.Aselectiveapproachtotheresectionofcysticlesionsofthepancreas:resultsfrom539consecutivepatients.AnnalsofSurgery.Adsayetal.Cystic siaofthepancreas:pathologyandbiology.JGastrointestSurg.2008;12(3):401-Al-HaddadetalIntegratedmolecularpathology ydeterminesthemalignantpotentialofpancreaticcysts.Endoscopyvt datDDW2014,in復(fù)雜的……

US,CT,MRI,EUSolitarycystSolitarycystMultiplecystsNoNocommunicationCommunicationBDIPMNPolycysticdiseaseTypicalTypicalaspectNotypicalaspectSuspiciouscystSCAPositivecytologyMicrocysticPositivecytology(EUS-FNA),SurgeryorFU

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HighamylaseLowHighamylaseLowamylaseLowCLowCEHighCENegativecytologyNegativecytology

Micro/MacrocysticSCACongenitalcyst

MC,PC,BDIPMNUSAoverallmortalityrateforWhipple’sprocedureisXGrade3complicationsarereportedtobe>30%whilethechanceofdevelopancreaticmalignancyis3%orless2-3X?Treatmentofpancreaticcystismuchworsethantheriskofgettingdisease ysurgeryisessentiallytheonlysolutiontopreventcancerKotwalletal.Nationalestimatesofmortalityratesforradicalpancreaticoduodenectomyin25,000patients.AnnSurgOncol smofthepancreasisnotanaggressiveentity:lessonsfrom163resectedpatients.AnnSurgAllenetal.Cysticlesionsofthepancreas:selectioncriteriaforoperativeandnonoperativemanagementin209patients.JGastrointestSurgEUS與FNAEUS鑒 性囊腫的能力較差精確性51敏感性56特異性45%

細(xì)胞學(xué)檢查的結(jié)果變異性較大CEA檢查也并非完美Bruggeetal.,Diagnosisofpancreaticcystic sms:areportofthecooperativepancreaticcyststudy,GastroenterologyThorntonetal.,PancreatologyVanderWaaij.GE2005,ThorntonPancreatology2013,ParkPancreasHaveyoueverhadtomakesuchadecision病例研究，DrNapoleon,HopitalPrivé nMermoz,Lyon,France?女性，50歲，無膽胰疾病的個(gè)人史 ?MRI&CT:EUS

FNA&?CEA=15ng/ml,=274UI/l 性

監(jiān)督？手術(shù) maofthePancreasaModelofClear-genesis?Pancreatology2009假如可能的話，您將看到……針

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搭載CellvizioCLE工0,8mmIntendeduseasperFDAclearance:TheAQ-Flex?19(...)probecanbeusedwithinanatomicaltracts,gastrointestinal,accessedbyandendoscopeorendoscopicaccessories, EUS-FNAFullFull-clickAQ-Flex迷你探頭預(yù)置在標(biāo)3撤出mini當(dāng)囊腫被穿刺后，將mini探頭與囊壁接觸即可開始nCLECellvizio內(nèi)置參 自然融入所有的EUSFNAUS,CT,MRI,EUBDIPMN病SCEUSFNA+

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INSPECT8 中心，66例患0% 25%鑒別IPMN特異性為100%

50% 100%AcceptedforpublicationinBeckerV,WallaceMB,FockensP,etGIE2010Konda,Aslanian,Wallaceetal,

KondaV.J.etal.Apilotstudyofinvivoidentificationofpancreaticcystic smswithneedle-basedconfocallaserendomicroscopyunderendosonographicguidance.Endoscopy2013文獻(xiàn)/Kondaetal.Kondaetal.INSPECTNapoléonetal.

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可行性被證?驗(yàn)證nCLE探頭設(shè)??確立使用方?建立胰腺囊腫最初的圖圖像解析標(biāo)準(zhǔn)建立并測確 凸起物為預(yù)測IPMN囊腫的標(biāo)獲得了nCLE診斷胰腺囊腫精確度的最初數(shù)確定淺表 標(biāo)準(zhǔn)為預(yù)測漿液性囊腺瘤的標(biāo)研究者間一致性獲得了nCLE鑒別胰腺囊腫精確

Changetal.DETECT

獲得了鑒別粘液性囊腫與非粘液性囊腫的精確度的數(shù)30 ?當(dāng)nCLE與SpyGlass相結(jié)合精確度和達(dá)PPVNPVINSPECT59%100%100%50%DETECT100%100%87%69%100%100%82%87%ApplicativeTrainingPancreaticCystsv2.00-Module3-ClinicalEvidence?2015Mauna多個(gè)臨床研究結(jié)果證nCLE使用SVN標(biāo)準(zhǔn)鑒別漿液性囊腺瘤特異100(敏感性69%)nCLE使用手指樣凸起物標(biāo)準(zhǔn)鑒別IPMN特性可100%敏感性59%77%)

KondaV,MeiningA,JamilL,GiovanniniM,HwangJH,WallaceM,ChangK,SiddiquiU,HartJ,LoS,SaundersM,AslanianH,WroblewskiK,WaxmanI.Apilotstudyofinvivoidentificationofpancreaticcysticneo smswithnCLEunderendosonographicguidance(INSPECT).Endoscopy2013NapoléonB,LemaistreAI,PujolB,CaillolF,LucidarmeD,BourdariatR,Morellon-MialheB,FumexF,LefortC,LepiliezV,PalazzoL,MongesG,FilocheB,GiovanniniM.Anovelapproachtothediagnosisofpancreaticcystadenoma:nCLE.EndoscopyNakaiY,IwashitaT,ParkD,SamarasenaJ,LeeJ,ChangK.Diagnosisofpancreaticcysts:Endoscopicultrasound-guidedthrough-the-needleconfocallaser-inducedendomicroscopyandcystoscopytrial:DETECTstudy.GIEAQ-FlexTM19Trainingv2-Module3-ClinicalEvidence?2015Mauna -FORUS 關(guān)鍵數(shù)nCLE敏感69%關(guān)鍵數(shù)nCLE敏感69%特異100%(CONTACT)IPMNnCLE敏感59%(INSPECT)及77%(DETECT)，特異100%在最初的EUSFNA術(shù)中發(fā)現(xiàn) 良性囊腫(漿液鑒 的IPMN患AQ-FlexTM19Trainingv2-Module3-ClinicalEvidence?2015Mauna -FORUS全球已有50家頂級(jí)醫(yī)療機(jī)構(gòu)成為nCLE的用1,000USA Europe Asia South胰腺病變的nCLE圖PreparedbyYourName?2014Mauna結(jié)締成纖維細(xì)胞組脂肪細(xì)CourtesyofDrLemaistreNapoléonetalCONTACTstudyUEGW2013腺Pathologyimagesobtainedafterchirugicalremovalofpancreas正常胰腺：NCLE黑色小葉結(jié)(?咖啡豆?)灰色卵圓形結(jié)胰腺導(dǎo)管 腫瘤(IPMN)：可見結(jié)上皮邊血管結(jié)締組織內(nèi)血IPMN：nCLE上皮邊血 上皮邊血CourtesyofDr.Kondaetal,INSPECTstudy,Endoscopy

=白 的黑色環(huán)狀結(jié)構(gòu)假性囊腫：假性囊腫：nCLE 粘液性囊腺瘤：100樣基致密結(jié)締組織+血

樣基質(zhì)粘液性囊腺瘤：nCLE上皮邊腔血標(biāo)準(zhǔn)尚在建立中

Tip:theepithelialbordermaybesingleinthiscase(di?erentfrom漿液性囊腺瘤：nCLE寬度各異的血可見血細(xì)

=淺表 (SVN)實(shí)時(shí)動(dòng)態(tài)成像令人嘆為觀淺表(SVN)黑色小葉結(jié)構(gòu)咖啡豆?)IPMN：手指樣凸起病例研PreparedbyYourName?2014Mauna病例研究病例研究，DrNapoleon,HopitalPrivé nMermoz,Lyon,France?女性，50歲，無膽胰疾病的個(gè)人史 ?MRI&CT:

EUS

FNA&?CEA=15ng/ml,=274UI/l無需手術(shù)或監(jiān)(CONTACT實(shí)特異性為病例研究個(gè)月前上腹部刺痛，生化分析：脂肪酶lipasex4,?兩周后行CT檢查：無急性或慢性胰腺炎表現(xiàn)，孤立囊腫4cm（胰頭部?MRI:無明顯的交通，無BD或主胰管擴(kuò)張，CBDEUS

FNA& ?CEA110109000小腸絨毛->IPMN*（INSPECT研究證實(shí)特異性100%）

*Basedon100%specificityfromINSPECTstudy,tobeconfirmedbyfurther??? ??? ????????左側(cè)胰腺切->MCN

標(biāo)準(zhǔn)建立中臨床操作流PreparedbyYourName?2014Mauna配合EUSFNA使用Cellvizio建議操作醫(yī)生在使用AQ-Flex19做EUS-FNA的nCLE病例之前有pCLE在消化道相關(guān)的使用經(jīng)至少跟三臺(tái)EUS-FNA的nCLE操作以確?？蛻舻玫阶銐虻呐嘤?xùn)，能夠恰 操作nCLE的計(jì)劃盡早（提前一個(gè)月）CellvizioInServicePresentationv5.03?2014Mauna -FOREMEA配合EUSFNA使用Cellvizio鎖定裝置內(nèi)口旋開，將AQ-Flex19探頭通過鎖定裝? -FOREMEA?配合EUSFNA使用CellvizioCellvizioInServicePresentationv5.03?2014Mauna -FOREMEA配合EUSFNA使用CellvizioWatchashortmovieonhowtousetheAQ-Flex19ConfocalMiniprobeduringEUS-FNACellvizioInServicePresentationv5.03?2014Mauna -FOREMEAAQ-Flex19 EchoTip?UltraEndoscopicUltrasoundNeedle

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胰腺炎是EUSFNA的潛在并發(fā)癥，為了避免其發(fā)生的風(fēng)險(xiǎn)，請(qǐng)按照以下推薦方nCLE成像時(shí)間不要超過10法),不要對(duì)迷你探頭過度施力：Cellv