Does ampullary adenoma size predict invasion on EUS? Does invasion on EUS predict presence of malignancy?

Patel, Vaishali

Jowell, Paul

Obando, Jorge

Guy, Cynthia D

Burbridge, Rebecca A

Germany

2017-05-01T18:00:06Z

2018-01-22T17:13:23Z

2018-01-22T17:13:23Z

2016-12

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).

https://www.ncbi.nlm.nih.gov/pubmed/27995195

2364-3722

https://hdl.handle.net/10161/16011

eng

Georg Thieme Verlag KG

Endosc Int Open

10.1055/s-0042-121001

http://hdl.handle.net/10161/14246

10161/14246

Does ampullary adenoma size predict invasion on EUS? Does invasion on EUS predict presence of malignancy?

Journal article

https://www.ncbi.nlm.nih.gov/pubmed/27995195

E1313

E1318

12

Clinical Science Departments

Duke

Medicine

Medicine, Gastroenterology

School of Medicine

Published

4