Okano Naoki, Igarashi Yoshinori, Hara Seiichi, Takuma Kensuke, Kamata Itaru, Kishimoto Yui, Mimura Takahiko, Ito Ken, Sumino Yasukiyo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
Clin Endosc. 2014 Mar;47(2):174-7. doi: 10.5946/ce.2014.47.2.174. Epub 2014 Mar 31.
BACKGROUND/AIMS: In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. This procedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy.
The subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy) who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographic evaluation and pathological diagnosis of these tumors.
The diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 50% for pT3-4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3-4 tumors, for an overall accuracy of 80% for T-staging.
EUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniques are not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequate for treating adenomas and pTis tumors.
背景/目的：近年来，已采用内镜圈套乳头切除术治疗 Vater 壶腹肿瘤。该手术需要准确的术前评估。在本研究中，我们使用内镜超声（EUS）和管内超声（IDUS）诊断此类肿瘤的局灶性扩展，并研究内镜圈套乳头切除术的适应证。
研究对象为 48 例乳头状肿瘤患者（13 例行手术切除；35 例行内镜圈套乳头切除术），术前均接受 EUS 和 IDUS 评估。采用肿瘤-淋巴结-转移分类对这些肿瘤进行内镜超声评估和病理诊断。
EUS 对腺瘤和 pTis 肿瘤的诊断准确率为 97%，对 pT1 肿瘤为 73%，对 pT2 肿瘤为 50%，对 pT3-4 肿瘤为 50%，T 分期的总体准确率为 85%。IDUS 对腺瘤和 pTis 肿瘤的诊断准确率为 94%，对 pT1 肿瘤为 73%，对 pT2 肿瘤为 50%，对 pT3-（此处原文有误，应为 pT3-4）肿瘤为 100%，T 分期的总体准确率为 80%。
EUS 和 IDUS 能够高度准确地术前评估 Vater 壶腹肿瘤。然而，这些技术在术前评估癌的局灶性扩展方面并不充分。目前，内镜圈套乳头切除术适用于治疗腺瘤和 pTis 肿瘤。
