Accuracy of diagnostic performance of confocal laser endomicroscopy in characterising pancreatic cysts: A systematic review.

[INTRODUCTION] Pancreatic cystic lesions (PCLs) are becoming more frequently diagnosed due to the improved crosssectional imaging. Although some of them are harmless, others are malignant in nature, and proper diagnosis is very crucial. This systematised review evaluates the diagnostic effectiveness of nCLE in characterising pancreatic cysts in terms of sensitivity, specificity, diagnostic yield, as well as its strengths versus conventional diagnostic techniques.

[MATERIALS AND METHODS] The systematic literature search was performed in PubMed, Scopus, and Google Scholar, including papers published between 2011 and March 2025. The inclusion criteria were randomised, prospective, and retrospective research in which nCLE diagnostic accuracy was reported in PCLs. Meta-analysis was conducted using PRISMA guidelines for data extraction, risk of bias assessment, and sensitivity analyses.

[RESULTS] The inclusion criteria were met in seventeen studies. As shown, nCLE was usually superior to cytology, cyst fluid carcinoembryonic antigen (CEA), and traditional EUS-FNA. Sensitivity was reported to be between 59-98% and specificity is between 82-100%. Of seven studies (n=216 cases) analysed by meta-analysis, the pooled sensitivity was 0.89 (fixed-effects) and 0.88 (random-effects), the heterogeneity was high (I2=74%). The Funnel plot analysis identified the possibility of publication bias and small-study effects. Robustness was ensured through sensitivity analysis, which was always pooled between 0.86-0.92.

[CONCLUSION] It has been noted that nCLE improves diagnostic confidence, reduces indeterminate results, and has the potential to positively influence the economy and clinical management. The current evidence is strongly in favour of the clinical utility of nCLE, more large-scale, multicentred, and methodologically sound trials are necessary to determine the diagnostic performance of the technique, develop standardised protocols, and evaluate long-term effects on patient outcomes and healthcare systems.