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

Skordilis P, Mouzas IA, Dimoulios PD, Alexandrakis G, Moschandrea J, Kouroumalis E - BMC Surg (2002)

Bottom Line: Results were compared to surgical findings.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.Tumor extension and locally metastatic lymph nodes are more accurately assessed by means of EUS than with other imaging methods.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Hospital of Crete, Gastroenterology Department. pansk@caramail.com

ABSTRACT

Background: The 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.

Aim: To 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 methods: 20 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.

Results: Endoscopic 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%.

Conclusion: EUS 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.

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Related in: MedlinePlus

Polypoid, exophytic mass of the ampulla of Vater. Endoscopic appearance (T: tumour mass).
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Figure 1: Polypoid, exophytic mass of the ampulla of Vater. Endoscopic appearance (T: tumour mass).

Mentions: The endoscopic appearance of the papilla was abnormal (polypoid or exophytic tumour mass) in 17/20 patients (Fig. 1, Fig 3). In three cases the tumour was evident only after endoscopic sphincterotomy of a protruding papilla. In the rest of the cases a tumour mass was evident. On ERCP a dilatation of the peripheral part of the common bile duct (15/20) and of the main pancreatic duct (6/20) were found. Multiple endoscopic biopsies were taken from 17 patients. In one patient endoscopic biopsies showed only severe dysplasia, while in three patients the biopsies were normal. Carcinoma of the ampulla of Vater was diagnosed in the remaining 13 patients.


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

Skordilis P, Mouzas IA, Dimoulios PD, Alexandrakis G, Moschandrea J, Kouroumalis E - BMC Surg (2002)

Polypoid, exophytic mass of the ampulla of Vater. Endoscopic appearance (T: tumour mass).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC101389&req=5

Figure 1: Polypoid, exophytic mass of the ampulla of Vater. Endoscopic appearance (T: tumour mass).
Mentions: The endoscopic appearance of the papilla was abnormal (polypoid or exophytic tumour mass) in 17/20 patients (Fig. 1, Fig 3). In three cases the tumour was evident only after endoscopic sphincterotomy of a protruding papilla. In the rest of the cases a tumour mass was evident. On ERCP a dilatation of the peripheral part of the common bile duct (15/20) and of the main pancreatic duct (6/20) were found. Multiple endoscopic biopsies were taken from 17 patients. In one patient endoscopic biopsies showed only severe dysplasia, while in three patients the biopsies were normal. Carcinoma of the ampulla of Vater was diagnosed in the remaining 13 patients.

Bottom Line: Results were compared to surgical findings.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.Tumor extension and locally metastatic lymph nodes are more accurately assessed by means of EUS than with other imaging methods.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Hospital of Crete, Gastroenterology Department. pansk@caramail.com

ABSTRACT

Background: The 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.

Aim: To 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 methods: 20 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.

Results: Endoscopic 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%.

Conclusion: EUS 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.

Show MeSH
Related in: MedlinePlus