title: Feasibility and preliminary accuracy of high-resolution imaging of the liver and pancreas using FNA compatible microendoscopy (with video).
abstract: BACKGROUND
  EUS-guided FNA is one of the few techniques that can obtain cells and tissue from the liver and pancreas. However, the technique remains vulnerable to poor specimen quality and sampling error.
  
  
  OBJECTIVE
  To evaluate the ability of a high-resolution microendoscope (HRME) to visualize the cellular and architectural features of normal and malignant liver and pancreatic tissue ex vivo, to assess the ability of endosonographers to identify normal and neoplastic tissue by using HRME images, and to demonstrate preliminary technical feasibility of in vivo HRME imaging via EUS fine-needle puncture (FNP).
  
  
  METHODS
  Ex vivo pilot feasibility study in human tissue; in vivo swine model.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  Co-registered HRME images and biopsies were obtained from surgically resected hepatic and pancreatic tissues from 44 patients.
  
  
  METHODS
  Images were divided into training (12 images) and test (80 images) sets containing a range of normal and pathologic conditions for each organ. After viewing the training sets, 9 endosonographers attempted to distinguish malignant tissue from normal or benign lesions in the test sets, each of which contained 40 unique images with individual diagnoses from pathology.
  
  
  METHODS
  Image acquisition feasibility, ex vivo and in vivo. Ability of endosonographers to recognize features of normal/benign or malignant tissue from the liver and pancreas.
  
  
  RESULTS
  Overall, the 9 endosonographers achieved median accuracy figures of 85% in the liver and 90% in the pancreas. The endosonographers with prior experience in reading HRME images achieved accuracy rates between 90% and 95%. Technical feasibility of HRME imaging through a 19-gauge EUS-FNP needle was demonstrated in an in vivo swine model.
  
  
  CONCLUSIONS
  Ex vivo study.
  
  
  CONCLUSIONS
  High-resolution microendoscopy allows real-time imaging of cellular-level morphology and tissue architecture in the liver and pancreas. The technique appears to have a short learning curve, after which endosonographers achieved high accuracy rates in distinguishing malignant tissue from normal and benign pathology in both organs. Translating this imaging platform to the in vivo setting appears technically feasible.
authors: Department of Medicine, Columbia University, New York, New York, USA.
authors: Renu
authors: R
authors: Regunathan
authors: Jenny
authors: J
authors: Woo
authors: Mark C
authors: MC
authors: Pierce
authors: Alexandros D
authors: AD
authors: Polydorides
authors: Mohammad
authors: M
authors: Raoufi
authors: Sasan
authors: S
authors: Roayaie
authors: Myron
authors: M
authors: Schwartz
authors: Daniel
authors: D
authors: Labow
authors: Dongsuk
authors: D
authors: Shin
authors: Rei
authors: R
authors: Suzuki
authors: Manoop S
authors: MS
authors: Bhutani
authors: Lezlee G
authors: LG
authors: Coghlan
authors: Rebecca
authors: R
authors: Richards-Kortum
authors: Sharmila
authors: S
authors: Anandasabapathy
authors: Michelle Kang
authors: MK
authors: Kim
mesh_terms: D000818:Animals; D019723:Endoscopes; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D059032:Learning Curve; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008853:Microscopy / Q000295:instrumentation*; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D010865:Pilot Projects; D013552:Swine