Menzel J, Hoepffner N, Sulkowski U, Reimer P, Heinecke A, Poremba C, Domschke W
Department of Medicine B, University of Muenster, Muenster, Germany.
Gastrointest Endosc. 1999 Mar;49(3 Pt 1):349-57. doi: 10.1016/s0016-5107(99)70012-x.
An adenoma-carcinoma sequence also applies to adenomas of the major duodenal papilla. Therefore accurate preoperative diagnosis and tumor staging are essential to select the appropriate patients for adequate treatment. In a prospective, histopathologically controlled study of tumors of the main duodenal papilla, the preoperative diagnostic value of ultrasound (US) catheter probes applied during endoscopic retrograde cholangiopancreatography (ERCP) was investigated.
Intraductal US was compared with conventional endoscopic ultrasonography (EUS) and computed tomography (CT). In 27 consecutive patients with benign polypoid tumors of the major duodenal papilla (n = 12) and carcinomas of the papilla (n = 15), respectively, the value of these imaging procedures in determining tumor visualization, tumor diagnosis and tumor staging according to the TNM classification was assessed. Every patient underwent surgical resection; histopathologic evaluation of resected specimens served as the reference standard.
Intraductal US was significantly superior to EUS and CT in terms of tumor visualization (100% vs 59.3% vs 29.6%, respectively). Sensitivity and specificity rates for intraductal US and EUS were 100% versus 62.5% and 75% versus 50%, respectively. Overall accuracy rate in tumor diagnosis for intraductal US (88.9%; 24 of 27) was significantly (p = 0.05) superior to EUS (56.3%; 9 of 16). The latter did not depict 4 adenomas and 7 carcinomas. Neither intraductal US nor EUS is suitable for detection of distant metastases.
Intraductal US appears to be the most effective imaging method in visualizing, diagnosing and staging tumors of the major duodenal papilla. Combining ERCP with catheter probe sonography offers a new diagnostic modality that has some potential advantages for local staging of small tumors of the main duodenal papilla. Consequently, minimally invasive techniques for resection of seemingly benign tumors of the papilla or, even more so, of small carcinomas should preferably be based on intraductal US.
腺瘤-癌序列也适用于十二指肠主乳头腺瘤。因此，准确的术前诊断和肿瘤分期对于选择合适的患者进行充分治疗至关重要。在一项关于十二指肠主乳头肿瘤的前瞻性、组织病理学对照研究中，研究了内镜逆行胰胆管造影（ERCP）期间应用超声（US）导管探头的术前诊断价值。
将导管内超声与传统内镜超声（EUS）和计算机断层扫描（CT）进行比较。分别对27例连续的十二指肠主乳头良性息肉样肿瘤患者（n = 12）和乳头癌患者（n = 15），评估这些成像检查在根据TNM分类确定肿瘤可视化、肿瘤诊断和肿瘤分期方面的价值。每位患者均接受手术切除；切除标本的组织病理学评估作为参考标准。
在肿瘤可视化方面，导管内超声明显优于EUS和CT（分别为100%、59.3%和29.6%）。导管内超声和EUS的敏感性和特异性率分别为100%对62.5%以及75%对50%。导管内超声在肿瘤诊断中的总体准确率（88.9%；27例中的24例）明显（p = 0.05）高于EUS（56.3%；16例中的9例）。后者未显示4例腺瘤和7例癌。导管内超声和EUS均不适用于检测远处转移。
导管内超声似乎是十二指肠主乳头肿瘤可视化、诊断和分期最有效的成像方法。将ERCP与导管探头超声检查相结合提供了一种新的诊断方式，对十二指肠主乳头小肿瘤的局部分期具有一些潜在优势。因此，对于乳头看似良性肿瘤甚至小癌的切除，微创技术最好基于导管内超声。
