Table 2: Odds of Cytologic Diagnosis of Malignancy by FNA Pass # (compared to Pass 1) Mo1166 The Management and Assessment of Incidental Pancreatic Cysts on Computer Tomography in a Non-Pancreatic Centre Usman A. Sheikh, Shanil Kadir, Javaid Iqbal Introduction: With increased use and sensitivity of cross sectional imaging more incidental pancreatic cystic lesions are found. Studies have demonstrated a prevalence of 2.5% of cystic pancreatic lesions in asymptomatic patients on MRI & CT scanning. Cystic lesions have a wide variety of radiological appearances and prognostic outcomes. We aimed to review cases found to have incidental pancreatic cysts on CT scanning and ascertain the concordance between CT and EUS and the management of such lesions in a non-pancreatic centre. Method: We retrospectively reviewed patients undergoing EUS for pancreatic cystic lesions found on incidentally on CT scan between 2010 and 2012. Twenty-five patients were included. Solid lesions with a cystic component were excluded. Results: There were 15 female; 10 male. Indications for CT scan included abdominal pain 32%; weight loss 16%; jaundice and suspected stone disease with abnormal USS 16%. In all cases there was no preceding clinical suspicion of pancreatic cysts/disease. Median number of cysts was 1 (1- 4); mean size 3cm (1-11cm). In 70% of cases the cyst was >3cm; and <3cm in 30%. They were located in the HOP 36%; BOP 32%; TOP 16%; NOP 4%; multiple sites 12%. The cyst was aspirated +/- biopsy in 12 (48%) cases, of which in 2 (16%) this changed the CT diagnosis. Final diagnosis was pseudocyst 10 (40%); IPMN 6 (24%); simple cyst 2 (8%); serous cystadenoma 2 (8%); mucinous cystadenoma (MCA) 1 (4%); cystic adenoca 1 (4%); wegeners cyst 1 (4%); renal cyst 1 (4%). In 32% (8 cases), the EUS findings were inconsistent with CT findings, due to IPMN and MCA in the vast majority. Greatest concordance between EUS and CT findings was in the diagnosis of pseudocysts. Conclusion: Increasing number of asymptomatic pancreatic cysts found incidentally will undoubtedly cause increased refer- rals to tertiary pancreatic centres. EUS is a better imaging modality with additional benefit of attaining samples. Performing EUS +/- cyst FNA provided an alternative diagnosis to CT in a significant percentage (32%) of patients and helped streamline referrals for tertiary opinion. EUS should be considered in all patients presenting with incidental pancreatic cysts on cross-sectional imaging. This may be performed at the index hospital (if non-pancreatic centre) and should not be restricted to tertiary HPB centres if operator experience and confidence allows. Mo1167 Needle-Based Confocal Laser Endomicroscopy (nCLE) for the Diagnosis of Pancreatic Masses: Preliminary Criteria (Contact Study) Marc Giovannini, Fabrice Caillol, Damien Lucidarme, Bertrand Pujol, Flora Poizat, Genevieve M. Monges, Bernard Filoche, Bertrand Napoleon Introduction: Needle-based Confocal Laser Endomicroscopy (nCLE) is an imaging technique , which enables microscopic observation of solid organs, in vivo and in real-time, during an EUSFNA procedure. The CONTACT study (Clinical evaluation Of NCLE in The lymph nodes Along with masses and Cystic Tumors of the pancreas) aims at building an image atlas, and define interpretation criteria for nCLE images in the pancreatic masses. Patients and methods: 3 centres in France (7 investigators) took part in this prospective study. Any pancreatic mass studied by EUSFNA could be imaged by nCLE, but if a patient had multiple masses, only one of them could be imaged. The definition of the preliminary interpretation criteria was done by consensus, with 5 investigators, including one pathologist. 35 patients with a pancreatic mass were included prospectively during the study (June 2012 to March 2013) and the corresponding nCLE recordings were reviewed. For each case, the investigators had the following data: patient's clinical history, information on the EUS procedure preceding nCLE imaging, cytology, histology findings, nCLE sequences, and, in certain cases, histologi- cal images. When reviewing the video sequences, they were asked to identify characteristic descriptive criteria, and correlate them with a final diagnosis if possible. The localization of the pancreatic masses was: head (17 cases), body (12 cases), tail (6 cases). There were 17 men, and 16 women (2 na), mean age 66 years, (extreme: 32-87 years old). The puncture of the mass was done in all cases with a 19G puncture needle. Mean size is 30mm (+/- 9mm). Reesults: No complication occured during the nCLE procedure or the puncture. S-575 AGA Abstracts A definitive histological diagnosis was obtained in 31/35 patients. It was the following: adenocarcinoma (21 cases), fibrous stroma adenocarcinoma (1 case), neuroendocrine tumor (4 cases), pseudopapillary tumor (1), chronic pancreatitis (3). During this review, all exocrine adenocarcinomas showed 2 signs, dark cells aggregates with pseudo-glandular aspects, and straight hyperdense elements more or less thick corresponding to tumoral fibrosis. This last element was preposterous in the fibrous stroma tumor. However, both signs were absent in the tumor with acini cells and neuroendocrine tumor. This one showed a very dense network of small vessels on a dark background. Moreover, normal pancreas shows an aspect of coffee beans corresponding to acinis. Conclusion: This preliminary classification of nCLE images obtained in pancreatic masses could help in the differentiation of adenocarcinomas and neuroendocrine tumors, and between malignant tumors from normal pancreatic tissue. nCLE could therefore facilitate the diagnosis of these lesions, by bringing in vivo microscopic information, in real-time. pCLE image of an adenocarcinoma pCLE image of a neuroendocrine tumor Mo1168 EUS Elastography Strain Ratio of the Pancreatic Masses: Results Using Different Reference Area Milorad Opacic, Nadan Rustemovic, Katja Grubelic ´ Ravic ´, Dalibor Opac ˇic ´, Zvonimir Ostojic ´, Iva Ledinsky, Ana Višnjic ´, Hrvoje Ivekovic ´, Pave Markoš, Matea Majerovic ´ EUS elastography is a promising method in the differentiation of pancreatic masses using strain ratio (SR) for a measurement of tissue stiffness (1). Technical details of the method are described elsewhere (2,3). Aims: To evaluate the diagnostic value of the SR in the patients with pancreatic masses, and to determine the cut-off value between the pancreatic cancer and focal pancreatitis using a different reference area than previous investigators. Results are shown in the table. Methods: In a prospective single center study 149 patients were examined: 105 with the pancreatic masses and 44 controls. Strain values were recorded using Pentax EUS linear probe FG 38 UX and EG- 3870 UTK in combination with Hitachi 8500 and Hitachi Avius. SR was automatically calculated by machine software after strain was measured in regions of interest (over the tumor and over the neighboring part of homogenous pancreatic tissue representing reference area). After the diagnosis was estab- lished two groups were formed: pancreatic cancer group with positive cytology or histology after surgery (58 patients) and focal pancreatitis group with negative cytology and follow up after 3 and 6 months (47 patients). All statistical analysis has been made in SPSS 14.0 (SPSS Inc., Chicago, IL, USA). Discussion: In the previous studies (2,3) the biggest available area of the focal lesion and a small soft (red) area described as peripancreatic tissue were used for the calculation of the SR. We think that contiguous pancreatic tissue could be more clearly defined than peripancreatic tissue. Compared with these studies our data showed similar sensitivity and specificity in the pancreatic cancer detection using 7,59 as SR cut- off value, but with higher overall accuracy and positive predictive value . On the other hand, diffuse inflammation and fibrosis in chronic pancreatitis could change the elasticity value of the reference area to some degree, but according to our results not enough to reach significant influence on the final results. Conclusion: Statistical analysis in our study showed that SR with a cut-off value of 7.59 reaches 100% sensitivity and 95 % specificity AGA Abstracts