P1423 - Improving Risk Stratification of Intraductal Papillary Mucinous Neoplasms Through Consensus Guidelines and Confocal Endomicroscopy Imaging

Troy Cao, BS¹, Matt Leupold, MD², Stacey Culp, PhD³, Wei-Lun Chao, PhD⁴, Phil Hart, MD³, Wei Chen, MD, PhD¹, Zarine Shah, MD¹, Timothy Pawlik, MD, PhD, MPH, MBA¹, Somashekar Krishna, MD^5
1Ohio State University Wexner Medical Center, Columbus, OH; ²The Ohio State University Wexner Medical Center, Columbus, OH; ³The Ohio State University, Columbus, OH; ⁴Ohio State University, Columbus, OH; ⁵The Ohio State Wexner Medical Center, Columbus, OH

Introduction: The revised Fukuoka 2017 International Consensus Guidelines (ICG) for branch duct (BD)-IPMNs are extensively employed; however, the diagnostic accuracies for distinguishing BD-IPMNs with low-grade dysplasia (LGD) from high-grade dysplasia/adenocarcinoma (HGD-Ca) remain suboptimal. EUS-guided needle-based confocal endomicroscopy (EUS-nCLE) has shown promising diagnostic performance in predicting HGD-Ca in IPMNs. The objective of this study is to integrate nCLE variables with existing ICG guidelines to enhance the differentiation of BD-IPMNs.

Methods: Subjects with available reference histopathology for BD-IPMNs were enrolled from prospective databases at a single center (2015-2023). Unedited EUS-nCLE videos were reviewed by a blinded expert and for each subject, parameters of papillary size, epithelial darkness, epithelial thickness, and density were documented (Fig. 1). The diagnostic performance in identifying HGD-Ca for ICG high-risk criteria and nCLE variables were assessed. Multivariable logistic regression was further performed to predict HGD-Ca.

Results: In 67 enrolled subjects, the mean (±SD) age was 67.5±9.7 years, and 43.3% were female. The mean (±SD) BD-IPMN diameter was 34.6±10.3 mm. HGD-Ca was detected in 24 (35.8%) of the BD-IPMNs. The sensitivity, specificity, and accuracy for detecting HGD-Ca using the 2017 ICG high-risk criteria were 46% (95% CI: 28-65%), 93% (95% CI: 81-98%), and 76% (95% CI: 65-85%), respectively. Table 1 presents diagnostic indices for each of the nCLE variables in predicting HGD-Ca. The variable with highest performance was papillary epithelial thickness (sensitivity: 63%, specificity: 81%, and accuracy: 75%). Logistic regression analysis to predict HGD-Ca using ICG high-risk classification and nCLE variables revealed that papillary epithelium thickness (OR 9.74, 95% CI 1.65-57.37) was the nCLE variable most predictive of HGD-Ca in BD-IPMNs. The integration of papillary epithelial thickness and ICG-high risk (Table 1) resulted in an improved sensitivity of 83% (95% CI: 64-93%) and enhanced accuracy of 79% (95% CI: 68-87%).

Discussion: By providing in vivo real-time visualization of cyst epithelium, EUS-nCLE allows for the characterization of papillary structures and enhances the accuracy of risk stratification in BD-IPMNs. This finding supports the ongoing initiatives in multicenter collaborations and the utilization of artificial intelligence-assisted models to further improve image analysis.



Disclosures:


Troy Cao, BS¹, Matt Leupold, MD², Stacey Culp, PhD³, Wei-Lun Chao, PhD⁴, Phil Hart, MD³, Wei Chen, MD, PhD¹, Zarine Shah, MD¹, Timothy Pawlik, MD, PhD, MPH, MBA¹, Somashekar Krishna, MD⁵. P1423 - Improving Risk Stratification of Intraductal Papillary Mucinous Neoplasms Through Consensus Guidelines and Confocal Endomicroscopy Imaging, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.