Needle-based confocal laser endomicroscopy and artificial intelligence in pancreatic cystic lesions: Insights and clinical advances.

PURPOSE OF THE REVIEW

To summarize recent advances in diagnosing and managing pancreatic cystic lesions (PCLs) with needle-based confocal laser endomicroscopy (nCLE), focusing on its principles, applications, safety, limitations, and the emerging role of artificial intelligence (AI).

FINDINGS

Endoscopic ultrasound (EUS)-guided nCLE allows real-time, high-resolution imaging of PCL epithelium, improving diagnostic accuracy over conventional methods such as cross-sectional imaging and cyst fluid analysis. Prospective studies and derivative analyses have validated nCLE as a reliable tool for differentiating mucinous from non-mucinous PCLs, identifying subtypes, and detecting advanced neoplasia in mucinous PCLs. Artificial intelligence (AI) integration in nCLE imaging improves sensitivity for advanced neoplasia detection, furthering precision PCL evaluation. Safety data show slightly higher but mostly mild, self-limited complications.

SUMMARY

EUS-nCLE has transformed real-time evaluation of PCLs, enabling accurate diagnosis and risk stratification. AI adoption promises standardized interpretation and efficiency. Future research should validate AI tools, integrate multidisciplinary approaches, and assess long-term outcomes.

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