Endoscopic ultrasound-guided through-the-needle microforceps biopsy and needle-based confocal laser-endomicroscopy increase detection of potentially malignant pancreatic cystic lesions: A single-center study

Figure 4 Received operating characteristics describing overall diagnostic accuracy of endoscopic ultrasound alone and in addition with fine needle aspiration or contrast-enhanced endoscopic ultrasound, needle-based confocal laser-endomicroscopy and/or with direct intracystic micro forceps biopsy for detecting malignancy. A: Comparison among endoscopic ultrasound (EUS) alone vs additional diagnostic techniques; B: Comparison among EUS alone vs EUS + EUS-guided needle-based confocal laser-endomicroscopy (nCLE) + EUS-guided through-the-needle direct intracystic micro forceps biopsy (mFB). ¹DeLong’s test for two received operating characteristics (ROC) curves comparing EUS-alone area under the ROC curve (red line) with EUS + fine needle aspiration (FNA)/contrast-enhanced (CE) (orange line), EUS + nCLE (yellow line), EUS + mFB (blue line) and EUS + nCLE + mFB (green line). ²DeLong’s test for two ROC curves comparing EUS + FNA/CE (orange line) with EUS + nCLE + mFB (green line). EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; Cystoscopy: Fiberoptic probe cystoscopy; nCLE: Endoscopic ultrasound-guided needle-based confocal laser-endomicroscopy; mFB: Endoscopic ultrasound-guided through-the-needle direct intracystic micro forceps biopsy; CE: Contrast-enhanced.