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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

Corresponding endosonographic image (7.5 MHz) of the same (fig. 1) patient. Hypoechoic mass invading the duodenal wall. Carcinoma of the ampulla of Vater:T2N0. (DL: duodenal lumen, T: tumour mass, CBD: common bile duct, m: muscularis propria, nLN: non metastatic lymph node, P: pancreas).
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Figure 2: Corresponding endosonographic image (7.5 MHz) of the same (fig. 1) patient. Hypoechoic mass invading the duodenal wall. Carcinoma of the ampulla of Vater:T2N0. (DL: duodenal lumen, T: tumour mass, CBD: common bile duct, m: muscularis propria, nLN: non metastatic lymph node, P: pancreas).

Mentions: On EUS tumour was identified in all patients. A heterogeneous hypoechoic mass was the common presentation (fig 2, fig 4). T and N classification was feasible in all cases. Invasion of the duodenal wall (T2) was found in 8 patients. Tumour invasion within 2 cm on the pancreatic parenchyma was found in 10 patients. These patients were classified as having a T3 carcinoma. Two patients had a tumour that invaded more than 2 cm into the pancreas and they were classified as T4. In 17 patients suspected metastatic lymph nodes were detected (N1).


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)

Corresponding endosonographic image (7.5 MHz) of the same (fig. 1) patient. Hypoechoic mass invading the duodenal wall. Carcinoma of the ampulla of Vater:T2N0. (DL: duodenal lumen, T: tumour mass, CBD: common bile duct, m: muscularis propria, nLN: non metastatic lymph node, P: pancreas).
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Corresponding endosonographic image (7.5 MHz) of the same (fig. 1) patient. Hypoechoic mass invading the duodenal wall. Carcinoma of the ampulla of Vater:T2N0. (DL: duodenal lumen, T: tumour mass, CBD: common bile duct, m: muscularis propria, nLN: non metastatic lymph node, P: pancreas).
Mentions: On EUS tumour was identified in all patients. A heterogeneous hypoechoic mass was the common presentation (fig 2, fig 4). T and N classification was feasible in all cases. Invasion of the duodenal wall (T2) was found in 8 patients. Tumour invasion within 2 cm on the pancreatic parenchyma was found in 10 patients. These patients were classified as having a T3 carcinoma. Two patients had a tumour that invaded more than 2 cm into the pancreas and they were classified as T4. In 17 patients suspected metastatic lymph nodes were detected (N1).

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