OCT Distinguishes Between Low- and High-Risk Cysts

Optical coherence tomography (OCT) can distinguish between pancreatic cysts that are at low risk for becoming malignant and those that are high-risk. Other optical techniques often fail to provide images that are clear enough to differentiate between the two types.

A: Photograph of the OCT instrument and imaging probe; B,B’: Gross appearance and magnified OCT image of the malignant mucinous cystic neoplasm (MCN); C,C’: Gross appearance and magnified OCT image of the benign serous cystic adenoma (SCA). MCNs have large cavities filled with a mucinous fluid that scatters light (yellow arrow), while SCAs have a honeycomb structure of smaller cavities separated by tiny septae (red arrow). The SCA fluid is optically transparent and does not scatter light. OCT scale bar: 500 μm. (Images: Nicusor Iftimia, Physical Sciences Inc., and William Brugge, Massachusetts General Hospital)

A team of researchers from four Boston-area institutions, led by Nicusor Iftimia of Physical Sciences Inc., used OCT to examine pancreatic tissue samples from patients with cystic lesions. By identifying unique features of the high-risk cysts that appeared in the OCT scans, the group developed a set of visual criteria to differentiate between high- and low-risk cysts. They then tested the criteria by comparing OCT diagnoses to those obtained by examining thin slices of the pancreatic tissue under a microscope. Their results, described in the August issue of the journal Biomedical Optics Express, showed that OCT allowed differentiation between low- and high-risk cysts with a success rate close to that achieved by microscope-assisted examinations of slices of the same samples.

Future studies by the research team will focus on improving imaging resolution to further differentiate between solid lesions and autoimmune pancreatitis, and to test this technology in vivo. The group recently received FDA approval for testing this technology in human patients by using an OCT probe small enough to be inserted into the pancreas through a biopsy needle, which will be guided into suspect masses in the pancreas by endoscopic ultrasound imaging.

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