Ampulla of Vater tumors: impact of intraductal ultrasound and transpapillary endoscopic biopsies on diagnostic accuracy and therapy.

BACKGROUND AND STUDY AIMS: To evaluate the diagnostic impact of intraductal ultrasound (IDUS) and endoscopic transpapillary forceps biopsies (ETP) in ampullary tumors.

PATIENTS AND

METHODS

Seventy-two patients with suspected ampullary tumor were examined by ERCP, including IDUS and ETP. Histopathological correlation or long-term follow-up was available for all patients undergoing these procedures. Final diagnosis revealed ampullary adenoma in 40 patients and ampullary carcinoma in 32 cases. Sensitivity, specificity, accuracy rates as well as positive and negative predictive values (PPV, NPV) for each of the diagnostic measures were calculated including T and N stage accuracy.

RESULTS

Four carcinomas were misclassified by IDUS giving sensitivity, specificity and accuracy rates of 87.5%, 92.5% and 90.2%, respectively. Using ETP a correct pre-interventional diagnosis of ampullary carcinoma was achieved in 22 out of 32 patients resulting in a sensitivity, specificity and accuracy data of 68.7%, 100% and 86%, respectively. Improvement of sensitivity and accuracy to 97% and 94.5%, respectively, could be achieved by IDUS in combination with ETP. IDUS accuracy for T1, T2 and T3 stages was 86%, 71% and 86%, respectively. For NO and N1 stages accuracy of 75% each was calculated.

CONCLUSIONS

IDUS+ETP substantiate the diagnosis and further management of ampullary tumors. ETP alone is not useful in detecting malignancy (false-negative rate of 31.3%). IDUS accurately predicts T and N stages in patients and is able to accurately predict cases which potentially are treatable endoscopically.