Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Ampullary 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. Methods: We 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. Results: Final 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. Conclusions: Endoscopy 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.
Abstract
Background/Aims: Ampullary 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. Methods: We 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. Results: Final 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. Conclusions: Endoscopy 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.
참고문헌 (28)
- Hartel M, "Carcinoid of the ampulla of Vater", J Gastroenterol Hepatol, 20, pp.676~681 (2005)
- 조영심, "내시경 절제술로 치료한 팽대부 주위 신경절세포 부신경절종 1예", 대한내과학회지, 79(5), pp.543~548 (2010), 대한내과학회
- Artaza T, "Lymphangioma of Vater’s ampulla: a rare cause of obstructive jaundice. Endoscopic therapy", Scand J Gastroenterol, 30, pp.804~806 (1995)
- Culebras Fernández JM, "Leiomyoma of Vater’s ampulla", Rev Esp Enferm Apar Dig, 42, pp.165~172 (1974)
- 최용혁, "Clinical, Pathological, and Immunohistochemical Features of Adenomyoma in the Ampulla of Vater", 대한소화기학회지, 62(6), pp.352~358 (2013), 대한소화기학회
- Venu RP, "Ampullary hamartoma: endoscopic diagnosis and treatment", Gastroenterology, 100, pp.795~798 (1991)
- Yamaguchi K, "Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors", Gastrointest Endosc, 36, pp.588~592 (1990)
- Rodríguez C, "How accurate is preoperative diagnosis by endoscopic biopsies in ampullary tumours?", Rev Esp Enferm Dig, 94, pp.585~592 (2002)
- Menzel J, "Tumors of the papilla of Vater: inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy", Ann Oncol, 10, pp.1227~1231 (1999)
- Elek G, "Histological evaluation of preoperative biopsies from ampulla vateri", Pathol Oncol Res, 9, pp.32~41 (2003)
- Grobmyer SR, "Contemporary results with ampullectomy for 29 'benign' neoplasms of the ampulla", J Am Coll Surg, 206, pp.466~471 (2008)
- Kimchi NA, "The contribution of endoscopy and biopsy to the diagnosis of periampullary tumors", Endoscopy, 30, pp.538~543 (1998)
- DeOliveira ML, "Carcinoma of the papilla of Vater: are endoscopic appearance and endoscopic biopsy discordant?", J Gastrointest Surg, 10, pp.1140~1143 (2006)
- Morales TG, "Acute pancreatitis following endoscopic biopsy of the ampulla in a patient with Gardner’s syndrome", Gastrointest Endosc, 40, pp.367~369 (1994)
- Park JS, "The clinical significance of papillitis of the major duodenal papilla", Gastrointest Endosc, 55, pp.877~882 (2002)
- Seifert E, "Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study", Am J Gastroenterol, 87, pp.37~42 (1992)
- Ponchon T, "Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater", Cancer, 64, pp.161~167 (1989)
- Bourgeois N, "Endoscopic biopsies of the papilla of Vater at the time of endoscopic sphincterotomy: difficulties in interpretation", Gastrointest Endosc, 30, pp.163~166 (1984)
- Leese T, "Tumours and pseudotumours of the region of the ampulla of Vater: an endoscopic, clinical and pathological study", Gut, 27, pp.1186~1192 (1986)
- Choi YR, "Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater", World J Gastroenterol, 19, pp.2037~2043 (2013)
- Sivak MV, "Clinical and endoscopic aspects of tumors of the ampulla of Vater", Endoscopy, 20(1), pp.211~217 (1988)
- Blackman E, "Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study", Hum Pathol, 16, pp.901~910 (1985)
- Kim S, "CT evaluation of the bulging papilla with endoscopic correlation", Radiographics, 27, pp.1023~1038 (2007)
- Manta R, "Linear endoscopic ultrasonography vs magnetic resonance imaging in ampullary tumors", World J Gastroenterol, 16, pp.5592~5597 (2010)
- Kalady MF, "Clinical utility of positron emission tomography in the diagnosis and management of periampullary neoplasms", Ann Surg Oncol, 9, pp.799~806 (2002)
- Uchiyama Y, "New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system", J Gastroenterol, 41, pp.483~490 (2006)
- Ito K, "Diagnosis of ampullary cancer", Dig Surg, 27, pp.115~118 (2010)
- Sauvanet A, "Are endoscopic procedures able to predict the benignity of ampullary tumors?", Am J Surg, 174, pp.355~358 (1997)