Wee Eric, Lakhtakia Sandeep, Gupta Rajesh, Anuradha Sekaran, Shetty Mahesh, Kalapala Rakesh, Monga Amitabh, Saravanan Arjunan, Rebala Pradeep, Ramchandani Mohan, Rao Guduru Venkat, Reddy Duvvuru Nageshwar
Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500 082, Andhra Pradesh, India.
Indian J Gastroenterol. 2012 Dec;31(6):324-32. doi: 10.1007/s12664-012-0248-3. Epub 2012 Sep 21.
Ampullary tumors are rare. Reports on ampullary tumor staging are heterogeneous and combine both periampullary and ampullary tumors. This study assessed the performance of endoscopic ultrasound (EUS) in the local staging of ampullary tumors only.
Data were collected retrospectively. We included patients with an ampullary tumor who underwent EUS and surgical resection. Tumor (T) and nodal (N) TNM staging for EUS and histopathological (HP) staging were compared.
From 2009 to 2010, a total of 79 patients with ampullary tumors were identified. Of these, 26 had both EUS and Whipple's surgery and were included (28 did not undergo resection, 13 had palliative surgery only and 12 had resection without EUS). For T staging by HP, there were 2 (7.7 %) T1, 11 (42.3 %) T2, 12 (46.2 %) T3 and 1 (3.8 %) T4 tumors. The accuracy of EUS T staging was 73.1 % with a Kappa value of 0.564 (p < 0.0001). The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) of EUS, respectively were 50.0 %, 91.7 %, 33.3 % and 95.7 % for T1 tumors; 81.8 %, 80.0 %, 75.0 % and 85.7 % for T2; 75.0 %, 92.9 %, 90.0 % and 81.3 % for T3 tumors. For N staging by HP, 17 (65.4 %) were N0 and 9 (34.6 %) N1. The N staging diagnostic accuracy was 80.8 % with a Kappa value of 0.586 (p = 0.003). The sensitivity, specificity, PPV, NPV for N0 disease were 82.4 %, 77.8 %, 87.5 % and 70.0 %, respectively while for N1 they were 77.8 %, 82.4 %, 70.0 % and 87.5 %, respectively.
EUS had a moderate strength of agreement with histopathology for both T and N staging, and a high diagnostic accuracy for nodal staging.
壶腹肿瘤较为罕见。关于壶腹肿瘤分期的报告并不统一，涵盖了壶腹周围肿瘤和壶腹肿瘤。本研究仅评估了内镜超声（EUS）在壶腹肿瘤局部分期中的表现。
回顾性收集数据。纳入接受了EUS检查和手术切除的壶腹肿瘤患者。比较EUS的肿瘤（T）和淋巴结（N）TNM分期与组织病理学（HP）分期。
2009年至2010年，共确定79例壶腹肿瘤患者。其中，26例同时接受了EUS检查和惠普尔手术并被纳入研究（28例未接受切除术，13例仅接受姑息手术，12例接受了无EUS检查的切除术）。HP分期的T分期中，T1期肿瘤2例（7.7%），T2期11例（42.3%），T3期12例（46.2%），T4期1例（3.8%）。EUS T分期的准确率为73.1%，Kappa值为0.564（p<0.0001）。EUS对T1期肿瘤的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）分别为50.0%、91.7%、33.3%和95.7%；对T2期分别为81.8%、80.0%、75.
