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Light scattering spectroscopy predicts malignant potential of pancreatic cysts
Light scattering spectroscopy, a novel optical technique based on a spatial gating fiber-optic probe, predicted the malignant potential of pancreatic cysts during routine diagnostic endoscopic ultrasound-guided fine-needle aspiration with significantly higher accuracy than current diagnostics.
The LSS tool’s ability to differentiate precancerous and benign cysts could help prevent unnecessary surgeries and lead to earlier pancreatic cancer diagnosis, researchers said.
Study investigator Douglas K. Pleskow, MD, AGAF, FASGE, associate professor of medicine at Harvard Medical School, clinical chief of the division of gastroenterology and director of the Colon and Rectal Cancer Program at the Cancer Center at Beth Israel Deaconess Medical Center, characterized this new technology as “transformative in the evaluation of pancreatic cysts” in a press release. “It provides a high level of precision in the detection of potential malignant transformation of these cysts,” he said.
Douglas K. Pleskow
Pancreatic cysts are common, occurring in about 3% to 15% of the U.S. population, and they are being identified more frequently — although often incidentally — due to improved cross sectional imaging with MRI and CT imaging, Pleskow told Healio Gastroenterology.
However, endoscopic ultrasound (EUS) has been shown to be more reliable than MRI or CT for differentiating between benign and malignant cysts. Physicians therefore rely on EUS-guided fine needle aspiration (FNA) biopsies and cytology to test for malignancy, but this fails about half of the time, which leaves surgery as the current gold standard for diagnosis of pancreatic cysts.
Pioneered by Lev T. Perelman, PhD, director of the Center for Advanced Biomedical Imaging and Photonics at Beth Israel Deaconess Medical Center, and colleagues, LSS-based diagnostic imaging technology differs from current diagnostics in its design to be used during EUS.
“The newly developed pancreatic cystic LSS device has a miniature fiber-optic probe which is passed through an FNA needle to directly contact the pancreatic cyst wall,” Pleskow said. “The probe collects data from several different sites within the cyst [and] an algorithm has been created to identify the spectra of backscattered light. This provides histologic properties of the cyst wall, thereby allowing fuller characterization of the cyst, [which] has been correlated with surgical specimens demonstrating high sensitivity and specificity. The unique feature of this tool enables non-invasive optical biopsies at multiple locations covering a major portion of the internal surface of the cyst.”
To evaluate the device’s accuracy, Pleskow and colleagues performed a double blind prospective study in which they used LSS to analyze 14 cysts during EUS-FNA and 13 postoperatively. The device correctly diagnosed the cysts with 95% accuracy (95% CI, 78-99), which was statistically superior to preoperative cytology, performing with just 58% accuracy (P = .002). Further, LSS diagnosis matched that of postoperative histopathology, the gold standard, in all cases.
“We believe that this technique can identify the presence of precancerous and early cancerous pancreatic cyst lesions, while simultaneously classifying them, thereby helping guide the decision for surgery or future follow-up,” Pleskow said.
While promising, further research is required to ensure LSS can be used in a variety of clinical situations, Pleskow added.
“At the present time LSS is not used for real-time evaluation of the pancreatic cysts. The data once collected is analyzed post procedure ... similar to obtaining cyst fluid and sending the samples to the lab,” he said. The information takes several days to return from the lab and the information is then communicated to the patient and referring physician, often increasing patient anxiety. We anticipate that real-time LSS data analysis will be available shortly. Once that is done we can let the patient know what the nature of the cyst is, with a very high level of certainty.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.