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Previous issue date: 2003 === O carcinoma da papila duodenal maior e classificado como uma neoplasia da regiao periampular. Sua incidencia varia entre 0,06 a 0,21 por cento nos achados de autopsia e corresponde a 5 por cento de todos os tumores malignos do trato gastrintestinal. Seu diagnostico preciso e precoce e fundamental para a decisao terapeutica, principalmente por apresentar o prognostico mais favoravel comparado as outras neoplasias periampulares. No entanto, o diagnostico obtido pela duodenoscopia nem sempre e confirmado pelo exame da biopsia endoscopica, em razao da dificuldade de diferenciar lesoes nao invasivas de carcinomas, mesmo por patologistas experientes. O objetivo deste trabalho foi avaliar o valor e a limitacao da duodenoscopia e da biopsia endoscopica no diagnostico do cancer de papila duodenal maior. Analisou-se retrospectivamente 30 doentes com suspeita de carcinoma de papila, sendo 11 do sexo feminino e 19 do sexo masculino; a idade variou de 39 a 71 anos, sendo a media de 55,7 anos. Todos os doentes foram submetidos a duodenopancreatectomia parcial, sendo o exame da peca operatoria o padrao ouro para a analise do valor dos testes. A acuracia e a sensibilidade da duodenoscopia para malignidade foram de 83,3 por cento e 86,2 por cento respectivamente, enquanto a acuracia e a sensibilidade da biopsia endoscopica foi de 66,6 por cento e 65,5 por cento. Ao comparar os metodos de diagnostico, nao houve diferenca significante entre a concordancia e a discordancia da duodenoscopia e da biopsia endoscopica === Carcinoma of the papilla of Vater is classified as periampullary cancer; 5% of all gastrointestinal tract malignant. Early and accurate diagnosis is important for those patients with tumor of the papilla as the prognosis is more favorable than others periampulary neoplasms. Endoscopically obtained biopsies from suspicious papillas can establish an early and immediate preoperative diagnosis, although even for skilled pathologists it is difficult to distinguish carcinomas from non-invasive lesions on the basis of forceps biopsies. The purpose of this study was to asses the preoperative diagnostic accuracy of duodenoscopy appearance and biopsy in all suspicious of tumor. Thirty patients with suspicious of carcinoma of the papilla of Vater and with final diagnosis established by Whipple’s procedure were included in this retrospectively study. In each case, a comparison was made between endoscopic biopsy and duodenoscopy appearance. A final diagnosis was established by surgical specimen. After surgery the resected tumors of the papilla of Vater were definitely diagnosed as adenocarcinomas in 96.7% (29 patients) and inflammatory non-neoplastic lesion in 3.3% (01 patient). Duodenoscopic appearance accuracy for malignancy was 83,32%. One case was diagnosed falsely as positive by duodenoscopy appearence. Endoscopic biopsy accuracy was 66,6%. When we compared both methods, we noticed that concordance value was 50%. === BV UNIFESP: Teses e dissertações
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