Pre-operative staging of ampullary tumours by endoscopic ultrasound.

Abstract

Ampullary carcinomas have a significantly higher resectability rate and better prognosis than other periampullary carcinomas, although the prognosis is poor with advanced disease. Accurate tumour staging is therefore important in surgical planning. Our objective was to evaluate the usefulness of, and problems associated with, endoscopic ultrasound (EUS) in the pre-operative staging of ampullary tumours. 35 patients with ampullary tumours were pre-operatively examined with EUS. The imaging results were compared with histopathological findings of the resected specimen according to the TNM staging classification. The overall accuracy of tumour (T) staging was 74% (26/35) for all tumours, and 67% (6/9), 71% (10/14) and 83% (10/12) respectively for T1, T2 and T3 tumours. The overall accuracy of nodal (N) staging was 63%. In diagnosing pancreatic invasion, EUS had an accuracy of 86% (30/35), a sensitivity of 83% (10/12), and a specificity of 87% (20/23). In conclusion, EUS provides an accurate method of evaluating the stage of ampullary tumours, especially infiltration into the pancreas. This modality is useful to surgeons in deciding on an appropriate therapeutic approach and in giving a prognosis.

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

“…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.…”

“…Some adenomas and carcinomas had echogenic components in our study. 1,16 The accuracy of EUS in T staging of ampullary tumors remains controversial. 9,17 In our series, the accuracy of EUS for T staging was 73%, which is comparable to previous reports.…”

“…Understaging can occur in the presence of minimal malignant infiltration of the pancreas. 1 It is important to differentiate a tumor limited to the duodenal wall from a tumor invading the pancreas, adjacent organs, or vessels, because better prognoses are expected in such T2 tumors undergoing radical resection. In our series, EUS was both sensitive (89%) and specific (83%) in diagnosing pancreatic infiltration.…”

“…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.…”

The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

“…Twenty-two papers (10%) matched the selection criteria while the remainder (197, 90%) were excluded [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . Seventeen articles were prospective [2,[4][5][6][9][10][11][12][13][14][15]18,[20][21][22][23][24] and five retrospective [7,8,16,17,19] . In all studies radiological findings where compared with both intraoperative findings and final histopathological analysis that were considered gold-standards of comparison.…”