Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors

Abstract

Background/AimsAmpullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis.MethodsWe compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy.ResultsFinal diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, two adenomyomas, one paraganglioma, and one neuroendocrine tumor. The diagnostic accuracy of endoscopic imaging or the initial biopsy was identical (67.3%). At least one test was concordant with the final diagnosis in all except two cases. Compared with the final diagnosis, endoscopic imaging tended to show more advanced tumors, whereas the initial biopsy revealed less advanced lesions. The diagnostic accuracy of the initial biopsy was influenced by the type of endoscope used and the final diagnosis, but not by the number of biopsies taken.ConclusionsEndoscopy has limited accuracy in the diagnosis of ampullary tumors. However, most cases with concordant endoscopic imaging and biopsy results are identical to the final diagnosis. Therefore, in cases where both of these tests disagree, re-evaluation with a side-viewing endoscope after resolution of papillitis is required.

Cap-assisted forward-viewing endoscopy to visualize the ampulla of Vater and the duodenum in patients with familial adenomatous polyposis

“…Vater is usually insufficient using this type of endoscope owing to the position of the ampulla at a tangential angle. 10,11 Therefore, international guidelines recommend that an additional sideviewing endoscopy is performed in patients with FAP. [5][6][7][8][9] Avoiding the need for an additional side-viewing endoscopy would be desirable.…”

Signet-ring cell carcinoma of the ampulla of Vater: a case diagnosed via repeated biopsies

“…Ogura et al have reported that endoscopic ultrasound-fine needle aspiration may be safely and accurately performed for the lesions of the ampulla of Vater and that it should be preferred over EST as a diagnostic modality [13]. Lee et al have reported about the need for re-evaluation using a side endoscope after the resolution of papillitis when endoscopic images and biopsy results are contrasting [14]. In addition, some reports have shown that the false-negative rate of the duodenoscopic appearance is only 14% [10].…”

Hemangioma of the major duodenal papilla complicated with bleeding

“…Однако эти исследования не всегда достаточно информативны, что не позволяет провести точную дооперационную диагностику [6]. Ряд авторов указывает, что диагностическая точность эндоскопии с био псией составляет 67,3 % [11]. Применяемые для уточнения диагноза контрастная компьютерная томография или магнитно-резонансная томография живота, эндоскопическая ультрасонография и тонкоигольная аспирационная биопсия под ЭУС-навигацией доступны не во всех клиниках, диагностическую точность последнего метода оценивают в ряде исследований в 62-85 % [12].…”

“…Наряду с бессимптомным течением гемангиомы верхних отделов ЖКТ могут проявляться кровотечением, абдоминальными болями и даже инвагинацией кишечника с непроходимостью и перфорацией [1,3]. Независимо от диагности-ческих возможностей дооперационная дифференциальная диагностика очень сложна [4,5] и поставить точный диагноз зачастую можно только после гистологического исследования препарата, удаленного во время операции [6].…”