**Author details**

nCLE has been studied mostly in investigation of pancreatic cystic lesions and shown to have an accuracy of 46–95% for diagnosing PC, with a low sensitivity 46–59%. Overall complication rate ranges from 0 to 2.5%; complications include bleeding, infection, pancreatitis and perforation [66]. Nakai et al. used a combination of EUS-guided cystoscopy (direct visualisation of the internal wall of a cystic lesion) and nCLE in the assessment of 30 patients with cystic pancreatic lesions. The sensitivity of cystoscopy was 90% for determining PCN vs. BPC, nCLE was 80% sensitive, and the combination of the two modalities was 100%

Kongkam et al. conducted a study to validate the CLE diagnostic criteria and found a 90.9% accuracy of EUS-nCLE among 22 patients [68]. They found malignant lesions displayed dark clumping with or without dilated vessels (<40 μm), while benign lesions were more likely to display white fibrous bands and normal acini. They also found good inter-observer agreement between the three blinded endoscopists (κ = 0.82) [68]. These results contrast that of Karstensen JG et al. (2018), who conducted a prospective, dual-centre study on 28 patients with pancreatic masses referred for EUS-FNA and found limited benefit above EUS-FNA alone by using the current proposed nCLE criteria. This study also found significant interobserver and intraobserver analysis of the proposed CLE criteria, suggesting the reproducibility of the procedure is currently suboptimal. They concluded that further development of the technology is needed to permit better delineation between benign and malignant disease [69]. More studies are required in this area before EUS-CLE can be recommended as an adjunct to

The use of EUS-nCLE to enable direct visualisation of molecular expression with pancreatic cancers has also been explored. Nakai et al. have shown proof-of-concept in the ability to directly image EGFR and survivin expression in porcine models in vivo. This study utilised the direct injection of fluorescein isothiocyanate-labelled antibodies against EGFR and survivin into the pancreas 30 min before EUS-nCLE to highlight the expression of EGFR and survivin, and showed good correlation between the EUS-nCLE images and histological analysis of the porcine pancreas ex vivo [70]. The use of similarly labelled antibodies to KRAS could assist in the stratification of precancerous lesions and direct

What about a section on molecular diagnosis personalised therapy. You cannot tell me that this will not be important in the future. I know self-citation is frowned upon but we have

EUS now has an integral and indeed indispensable role in the diagnosis, staging, and treatment of pancreatic cancer and its complications. It is likely that this technique will become

increasingly important in the management of patients with this condition.

EUS-FNA for routine analysis of solid pancreatic lesions.

sensitive [67].

88 Advances in Pancreatic Cancer

early-stage treatment.

**9. Conclusion**

published 3 articles in this space recently?

Cameron John McLaren1 \*, Daphne Day1,2, Daniel Croagh1,2, Andrew Strickland1,2 and Eva Segelov1,2

