Pancreatic cancer is on track to become the second leading cause of cancer-related deaths by 2030, yet there is a lack of accurate diagnostic tests for early detection. Intraductal papillary mucinous neoplasms (IPMNs) are precursors to pancreatic cancer and are increasingly being detected. Despite the development and refinement of multiple guidelines, diagnosing high-grade dysplasia or cancer in IPMNs using clinical, radiologic, endosonographic, and cyst fluid features still falls short in terms of accuracy, leading to both under- and overtreatment. EUS-guided needle-based confocal laser endomicroscopy (nCLE) is a novel technology that allows real-time optical biopsies of pancreatic cystic lesions. Emerging data has demonstrated that EUS-nCLE can diagnose and risk stratify IPMNs more accurately than conventional diagnostic tools. Implementing EUS-nCLE in clinical practice can potentially improve early diagnosis of pancreatic cancer, reduce unnecessary surgeries of IPMNs with low-grade dysplasia, and advance the field of digital pathomics. In this review, we summarize the current evidence that supports using EUS-nCLE as a diagnostic imaging biomarker for diagnosing IPMNs and for risk stratifying their degree of neoplasia. Moreover, we will present emerging data on the role of adding artificial intelligence (AI) algorithms to nCLE and integrating novel fluid biomarkers into nCLE.
胰腺癌预计到2030年将成为癌症相关死亡的第二大原因，但目前仍缺乏用于早期检测的准确诊断方法。导管内乳头状黏液性肿瘤（IPMN）是胰腺癌的前期病变，其检出率日益增加。尽管多项指南已制定并完善，但利用临床、影像学、超声内镜及囊液特征诊断IPMN中的高级别异型增生或癌症，其准确性仍显不足，导致治疗不足与过度治疗并存。超声内镜引导下针式共聚焦激光显微内镜（nCLE）是一项创新技术，可实现胰腺囊性病变的实时光学活检。最新研究表明，与传统诊断工具相比，EUS-nCLE能更精确地诊断IPMN并进行风险分层。在临床实践中应用EUS-nCLE有望提升胰腺癌的早期诊断率，减少低级别异型增生IPMN的不必要手术，并推动数字病理组学领域的发展。本文综述了当前支持将EUS-nCLE作为诊断IPMN及其瘤变程度风险分层的影像学生物标志物的证据。此外，我们将展示关于在nCLE中整合人工智能算法及新型液体生物标志物的最新研究进展。
肿瘤(癌症)患者之家