Article
Correlation of endoscopic ultrasonography (EUS) for differential diagnostic between inflammatory and malignant lesions of the papilla of Vater with results of histologic investigation
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Authors
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Uwe Will
- Klinik für Gastroenterologie, Waldklinikum, Gera, Deutschland
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Frank Meyer
- Klinik für Chirurgie, Universitätsklinikum, Magdeburg
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C. Ehrhardt
- Klinik für Gastroenterologie, Universitätsklinikum, Jena
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Hans Bosseckert
- Klinik für Gastroenterologie, Universitätsklinikum, Jena
| Published: | March 20, 2006 |
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Outline
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Objective: At present, precise differentiation between inflammatory and malignant lesions of the papilla of Vater (papilla) is not possible by any imaging procedure in a satisfying manner.The aim was to study whether endoscopic ultrasonography (EUS) as an initial diagnostic step i) may have the potential to distinguish between different tissue characteristics such as tumor growth or inflammation of the papilla because of its high resolution capacity and ii) is superior to the accuracy of histologic investigations in mucosal biopsies by the mean of a prospective collection and retrospective evaluation of the data.
Methods: Between 1995 and 2002, a significant pathologic finding at the papilla and the peripapillary region using EUS was revealed in 311 patients. In 133 patients, a biopsy for histologic investigation could not be obtained prior to the use of EUS. Diagnosis was set up using EUS, which tried to differentiate between benign or malignant lesions of the papilla. Histologic investigation of the 133 tumors of the papilla became possible by taking deep transpapillary biopsies following papillotomy, papillectomy or by obtaining specimens from surgical resections.
Results: Using EUS, differentiation between malignant and non-malignant lesions of the papilla or the peripapillary region was correct in 109 of 133 cases (82 %), whereas in 4 subjects (3 %), suspected EUS-based diagnosis "papillitis stenosans" was corrected to adenoma and carcinoma, respectively (n=2 each), by histologic investigation. In 20 of 133 patients with suspected malignant lesions, “papillitis stenosans” was detected resulting in an overall sensitivity of 92.3 % and specificity of 75.3 %.
Conclusion: EUS allows to detect small intraampullary tumors and segmental thickening of the wall of the prepapillary biliary duct, which can not be revealed by conventional imaging. In patients with biliary symptoms, EUS can reliably image and characterize a malignant lesion as first diagnostic step (detection rate, 82 %) and may be considered the basis for following diagnostic steps as well as to verify diagnosis correctly, e.g., using histologic investigation.
