Does ampullary adenoma size predict invasion on EUS? Does invasion on EUS predict presence of malignancy?
Background and study aims: It is common practice to perform ampullectomy without endoscopic ultrasound (EUS) for ampullary lesions < 1 cm but no data exists to support it. No studies have explored whether EUS findings of invasion correla...
Main Authors: | , , , , |
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Format: | Article |
Language: | English |
Published: |
Georg Thieme Verlag KG
2016-12-01
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Series: | Endoscopy International Open |
Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-121001 |
Summary: | Background and study aims: It is common practice to perform ampullectomy
without endoscopic ultrasound (EUS) for ampullary lesions < 1 cm but no data
exists to support it. No studies have explored whether EUS findings of invasion
correlate with malignancy or high-grade dysplasia (HGD) on pathology. We
explored the association between adenoma size, pathology results, and invasion
on EUS.
Patients and methods: This was a single-center retrospective cohort study
at a large tertiary care academic hospital. Chart review was performed for 161
patients with benign ampullary lesions on endoscopic biopsy (identified by
pathology records). The primary outcomes were mean size (mm) of adenomas and
pathology findings with and without intraductal and/or duodenal wall invasion on
EUS.
Results: Invasion was identified by EUS in 41 (34.1 %) of 120 patients who
underwent EUS. The mean size of the lesion in these patients was 20.9 mm
(± 11.6 mm) compared to 13.9 mm (± 11.3 mm, P = 0.0001) in patients
without invasion. A receiver operating characteristic (ROC) curve (AUC 0.73,
95 % CI 0.63 – 0.83) revealed 100 % sensitivity for absence of invasion on EUS
in lesions less than 6.5 mm. Invasion on EUS had sensitivity of 63.0 % (95 % CI
47.0 % – 77.0 %) and specificity 88.0 % (95 % CI 78.0 % – 95.0 %) for presence
of malignancy, HGD or invasion on pathology.
Conclusions: EUS should be considered for ampullary lesions > 6.5 mm.
This study provides evidence to support the practice of ampullectomy without EUS
for smaller adenomas. EUS evidence of invasion is highly specific for pathologic
malignancy, HGD, or invasion (which preclude endoscopic
ampullectomy). |
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ISSN: | 2364-3722 2196-9736 |