Clin Endosc.  2015 May;48(3):239-246. 10.5946/ce.2015.48.3.239.

Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors

Affiliations
  • 1Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea. smpark@chungbuk.ac.kr
  • 2Department of Pathology, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea.

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.

Keyword

Papillary tumors; Endoscopic examination; Diagnostic accuracy

MeSH Terms

Adenocarcinoma
Adenoma
Adenomyoma
Biopsy
Diagnosis
Diagnostic Errors
Endoscopes
Endoscopy*
Neuroendocrine Tumors
Papilledema
Paraganglioma

Figure

  • Fig. 1 Representative endoscopic imaging of ampullary tumors. (A) Papillitis, bulging, and edematous papilla with petechia. (B) Adenoma, discolored lobular/pine cone like tumor. (C) Adenocarcinoma, a reddish coarse nodular tumor associated with erosion and ready bleeding. (D) Adenomyoma, an enlarged major papilla and villous granularities around the papillary orifice. (E) Paraganglioma, even and firm nodular mass with a granular and villous mucosa. (F) Neuroendocrine tumor, bulging of the papilla, which has a smooth surface.

  • Fig. 2 Representative pathologic findings of ampullary lesions. (A) Papillitis (H&E stain, ×200). (B) Tubular adenoma (H&E stain, ×50). (C) Villous adenoma (H&E stain, ×100). (D) Adenocarcinoma-intestinal type (H&E stain, ×100). (E) Adenocarcinoma-pancreaticobiliary type (H&E stain, ×100). (F) Adenomyoma (H&E stain, ×100). (G) Neuroendocrine tumor (H&E stain, ×100).

  • Fig. 3 Endoscopic images of misdiagnosed cases by gross appearance. (A, B) Papillitis misdiagnosed as adenoma. (C) Adenoma misdiagnosed as carcinoma. (D) Carcinoma misdiagnosed as adenoma.

  • Fig. 4 The diagnostic accuracy of biopsy was influenced by the type of endoscope used. (A) Side-viewing versus forward-viewing endoscope (85.7% vs. 45.0%, p=0.004). (B) Final diagnosis, normal or papillitis versus adenoma versus adenocarcinoma (88.9% vs. 72.7% vs. 47.4%, p=0.007). (C) Number of biopsy specimens (2 vs. ≥3, 56.3% vs. 75.0%; p>0.05).


Cited by  1 articles

How to Improve Diagnostic Accuracy in Suspicious Ampullary Lesions?
Woo Hyun Paik, Jin-Hyeok Hwang
Clin Endosc. 2015;48(3):185-186.    doi: 10.5946/ce.2015.48.3.185.


Reference

1. Hartel M, Wente MN, Sido B, Friess H, Büchler MW. Carcinoid of the ampulla of Vater. J Gastroenterol Hepatol. 2005; 20:676–681. PMID: 15853978.
Article
2. Cho YS, Joo HJ, Seo EK, et al. A case of juxtapapillary gangliocytic paraganglioma treated with endoscopic resection. Korean J Med. 2010; 79:543–548.
3. Artaza T, Potenciano JM, Legaz M, Muñoz C, Talavera A, Sánchez E. Lymphangioma of Vater's ampulla: a rare cause of obstructive jaundice. Endoscopic therapy. Scand J Gastroenterol. 1995; 30:804–806. PMID: 7481550.
Article
4. Culebras Fernández JM, González Bueno CM. Leiomyoma of Vater's ampulla. Rev Esp Enferm Apar Dig. 1974; 42:165–172. PMID: 4822683.
5. Choi YH, Kim MJ, Han JH, et al. Clinical, pathological, and immunohistochemical features of adenomyoma in the ampulla of vater. Korean J Gastroenterol. 2013; 62:352–358. PMID: 24365734.
Article
6. Venu RP, Rolny P, Geenen JE, Hogan WJ, Komorowski RA. Ampullary hamartoma: endoscopic diagnosis and treatment. Gastroenterology. 1991; 100:795–798. PMID: 1993502.
Article
7. Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc. 1990; 36:588–592. PMID: 2279648.
Article
8. Rodríguez C, Borda F, Elizalde I, Jiménez Pérez FJ, Carral D. How accurate is preoperative diagnosis by endoscopic biopsies in ampullary tumours? Rev Esp Enferm Dig. 2002; 94:585–592. PMID: 12647408.
9. Menzel J, Poremba C, Dietl KH, Böcker W, Domschke W. Tumors of the papilla of Vater: inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol. 1999; 10:1227–1231. PMID: 10586341.
10. Elek G, Gyôri S, Tóth B, Pap A. Histological evaluation of preoperative biopsies from ampulla vateri. Pathol Oncol Res. 2003; 9:32–41. PMID: 12704445.
Article
11. Grobmyer SR, Stasik CN, Draganov P, et al. Contemporary results with ampullectomy for 29 "benign" neoplasms of the ampulla. J Am Coll Surg. 2008; 206:466–471. PMID: 18308217.
Article
12. Kimchi NA, Mindrul V, Broide E, Scapa E. The contribution of endoscopy and biopsy to the diagnosis of periampullary tumors. Endoscopy. 1998; 30:538–543. PMID: 9746162.
Article
13. DeOliveira ML, Triviño T, de Jesus Lopes Filho G. Carcinoma of the papilla of Vater: are endoscopic appearance and endoscopic biopsy discordant? J Gastrointest Surg. 2006; 10:1140–1143. PMID: 16966033.
Article
14. Morales TG, Hixson LJ. Acute pancreatitis following endoscopic biopsy of the ampulla in a patient with Gardner's syndrome. Gastrointest Endosc. 1994; 40:367–369. PMID: 8056246.
Article
15. Park JS, Kim MH, Lee SK, et al. The clinical significance of papillitis of the major duodenal papilla. Gastrointest Endosc. 2002; 55:877–882. PMID: 12024144.
Article
16. Seifert E, Schulte F, Stolte M. Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study. Am J Gastroenterol. 1992; 87:37–42. PMID: 1728122.
17. Ponchon T, Berger F, Chavaillon A, Bory R, Lambert R. Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater. Cancer. 1989; 64:161–167. PMID: 2471581.
Article
18. Bourgeois N, Dunham F, Verhest A, Cremer M. Endoscopic biopsies of the papilla of Vater at the time of endoscopic sphincterotomy: difficulties in interpretation. Gastrointest Endosc. 1984; 30:163–166. PMID: 6735092.
Article
19. Leese T, Neoptolemos JP, West KP, Talbot IC, Carr-Locke DL. Tumours and pseudotumours of the region of the ampulla of Vater: an endoscopic, clinical and pathological study. Gut. 1986; 27:1186–1192. PMID: 3781332.
Article
20. Choi YR, Han JH, Cho YS, et al. Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater. World J Gastroenterol. 2013; 19:2037–2043. PMID: 23599622.
Article
21. Sivak MV. Clinical and endoscopic aspects of tumors of the ampulla of Vater. Endoscopy. 1988; 20(Suppl 1):211–217. PMID: 3049059.
Article
22. Blackman E, Nash SV. Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study. Hum Pathol. 1985; 16:901–910. PMID: 4029945.
Article
23. Kim S, Lee NK, Lee JW, et al. CT evaluation of the bulging papilla with endoscopic correlation. Radiographics. 2007; 27:1023–1038. PMID: 17620465.
Article
24. Manta R, Conigliaro R, Castellani D, et al. Linear endoscopic ultrasonography vs magnetic resonance imaging in ampullary tumors. World J Gastroenterol. 2010; 16:5592–5597. PMID: 21105192.
25. Kalady MF, Clary BM, Clark LA, et al. Clinical utility of positron emission tomography in the diagnosis and management of periampullary neoplasms. Ann Surg Oncol. 2002; 9:799–806. PMID: 12374664.
Article
26. Uchiyama Y, Imazu H, Kakutani H, et al. New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system. J Gastroenterol. 2006; 41:483–490. PMID: 16799891.
Article
27. Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J. Diagnosis of ampullary cancer. Dig Surg. 2010; 27:115–118. PMID: 20551654.
Article
28. Sauvanet A, Chapuis O, Hammel P, et al. Are endoscopic procedures able to predict the benignity of ampullary tumors? Am J Surg. 1997; 174:355–358. PMID: 9324155.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr