Endoscopic ultrasound versus computed tomography for preoperative evaluation of primary ampullary tumors radiological evaluation of primary ampullary tumors

Abstract

Aim: the study aimed to compare the efficacy of endoscopic ultrasound (EUS) and computed tomography (CT) in detecting primary tumor and evaluating preoperative vascular and peripheral invasion in histopathologically proven malignant ampullar tumors. Material and Methods: fifty-two patients who underwent surgery or endoscopic ampullectomy for the primary ampullary tumors between 2014 and 2016 were evaluated. The demographic data and EUS, CT, pathology results of all patients were recorded. The efficacy of EUS and CT in detecting tumor, peripheral tissue invasion, and vascular tissue invasion was evaluated and compared with pathology results. Results: forty-nine patients had the Whipple procedure and 3 patients underwent endoscopic ampullectomy. In pathology results, all patients had adenocarcinoma histology, and the mean tumor diameter was 20.12 mm. The rate of peripheral tissue invasion and vascular invasion was 86.5%, 5.8% respectively. Ampullary mass was detected in 41 (78.8%) patients by EUS, in 35 (67.3%) by CT (p=0.002). Three patients had a vascular invasion in pathology. The sensitivity and specificity of EUS in detecting vascular invasion were 66% and 100%, respectively. CT failed to demonstrate vascular invasion in these 3 patients. Discussion: the results showed that EUS was superior to CT in detecting a mass, peripheral tissue invasion, and vascular invasion. Although EUS is superior to CT, CT plays an important role in the evaluation of distant metastases, and therefore CT and EUS are two important complementary radiological tests in the evaluation of these patients.