title: Needle-based confocal endomicroscopy for pancreatic cysts: the current agreement in interpretation.
abstract: OBJECTIVE
  Diagnosis of pancreatic cystic lesions (PCLs) remains challenging. EUS with FNA is limited by sampling error and nondiagnostic cytology. Needle-based confocal laser endomicroscopy (nCLE) performed during EUS can be used to improve diagnostic yield via FNA by providing in vivo histology of PCLs. However, the interobserver agreement (IOA) of nCLE of PCLs has yet to be studied.
  
  
  METHODS
  Fifteen deidentified nCLE video clips of PCLs were sent to 6 interventional endoscopists at 5 institutions. Six variables were assessed for IOA: presence or absence of (1) vessels, (2) villi, (3) dark clumps, (4) reticular pattern, (5) acinar cells pattern, and (6) debris. PCL interpretation was categorized as mucinous, serous, pseudocyst, malignant, or indeterminate and final diagnosis as benign, malignant, or indeterminate.
  
  
  RESULTS
  IOA ranged from "poor" to "fair." The K statistics were -.04 (SE = .05) for vessels, .16 (SE = .07) for villi, .22 (SE = .06) for dark clumps, .13 (SE = .06) for reticular pattern, .14 (SE = .06) for acinar cells pattern, .06 (SE = .06) for debris, .15 (SE = .03) for interpretation, .13 (SE = .05) for final diagnosis, and .19 (SE = .05) for image quality. The final diagnosis was malignant (10), benign (13), and indeterminate (2). The mean accuracy of the observers was 46%, with the lowest being 20% and highest being 67%.
  
  
  CONCLUSIONS
  The IOA and accuracy for PCL diagnosis were low. The results of this study support the need to identify and validate imaging criteria to determine whether nCLE has diagnostic value for pancreatic pathology. (
  
  
  BACKGROUND
  NCT02166086.).
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Kunal
authors.initials: K
authors.lastname: Karia
authors.affiliation: University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.affiliation: University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Vani J
authors.initials: VJ
authors.lastname: Konda
authors.affiliation: Division of Gastroenterology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
authors.affiliation: Division of Gastroenterology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.affiliation: University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Armeen
authors.initials: A
authors.lastname: Jamal-Kabani
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology*