Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study

Abstract

BackgroundThe relatively rare carcinoma of the ampulla of Vater is a neoplasia with a good prognosis compared to pancreatic cancer. Preoperative staging is important in planning the most suitable surgical intervention.AimTo prospectively evaluate the diagnostic accuracy of Endoscopic Ultrasonography (EUS) in comparison with conventional US and CT scan, in staging of patients with ampullary carcinoma.Patients and Methods20 patients (7 women and 13 men) with histologically proven carcinoma of the ampulla of Vater were assessed by EUS, CT scan and US. Results were compared to surgical findings.ResultsEndoscopic biopsies were diagnostic in 76% of the patients. Detection of ampullary cancer with US and CT scan was 15% and 20% respectively. Only indirect signs of the disease were identified in the majority of cases using these methods. Overall accuracy of EUS in detection of ampullary tumours was 100%. The EUS was significantly (p < 0.001) superior than US and CT scan in ampullary carcinoma detection. Tumour size, tumour extension and the existence of metastatic lymph nodes were also identified and EUS proved to be very useful for the preoperative classification both for the T and the N components of the TNM staging of this neoplasia. The diagnostic accuracy for tumour extension (T) was 82% and for detection of metastatic lymph nodes (N) was 71%.ConclusionEUS is more accurate in detecting ampullary cancer than US and CT scan. Tumor extension and locally metastatic lymph nodes are more accurately assessed by means of EUS than with other imaging methods.

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

“…The present study showed an accuracy of EUS in N staging of 67%, which is comparable or slightly higher than that of previous reports. 2,7,9 The few advanced tumors and malignant lymph nodes in our study could have contributed to this result. We noted that EUS was less effective in detecting malignant lymph nodes (7/15 [47%]) than in diagnosing benign lymph nodes (15/18 [83%]).…”

“…9,17 In our series, the accuracy of EUS for T staging was 73%, which is comparable to previous reports. 1,2,7,9 The problem encountered in our study was overstaging (7/33 [21%]) rather than understaging (2/ 33 [6%]). Overstaging may occur in the presence of peritumoral inflammation.…”

“…The criteria for vascular involvement were tumor protrusion into the vascular lumen, or loss of the interface between the tumor and the vascular wall, or the presence of collateral vessels when the main vessel could not be demonstrated. 2,9 The duration of the EUS procedure was about 30 minutes.…”

“…They tend to have a higher resectability rate and better subsequent prognosis than other periampullary carcinomas. 1,2 It has been reported that if ampullary carcinoma invades the pancreas, the incidence of lymph node metastasis increases, and prognosis is poor. 3,4 However, there is substantial support in the literature for local resection of T1 ampullary tumors because of the very low incidence of lymph node metastasis.…”

“…EUS can clearly delineate the pancreatic parenchyma and duct, common bile duct (CBD), and duodenal wall. For preoperative evaluation of ampullary tumors, EUS is more accurate than transabdominal sonography (US) or CT. 2,7,8 Despite the relative advantages of EUS, MRI, including magnetic resonance cholangiopancreatography, continues to be regarded as the most reliable noninvasive diagnostic imaging modality for the evaluation of pancreatobiliary lesions. 9,10 This retrospective study evaluated the accuracy of US, CT, MRI, and EUS in the preoperative staging of ampullary tumors.…”