Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Wiriyaporn Ridtitid, Suzette E. Schmidt, Mohammad A. Al-Haddad, Julia Leblanc, John DeWitt, Lee McHenry, Evan Fogel, James L. Watkins, Glen Lehman, Stuart Sherman, Gregory A. Coté

Research output: Contribution to journalArticle

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Abstract

Background The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear. Objectives To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions. Design Retrospective cohort study. Setting Tertiary-care referral center. Patients All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. Intervention EUS. Main Outcome Measurements Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy. Results We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively. Limitation Retrospective design. Conclusions EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection.

Original languageEnglish
Pages (from-to)380-388
Number of pages9
JournalGastrointestinal Endoscopy
Volume81
Issue number2
DOIs
StatePublished - Feb 1 2015

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Endoscopic Retrograde Cholangiopancreatography
ROC Curve
Surgical Pathology
Confidence Intervals
Tertiary Care Centers
Sensitivity and Specificity
Adenoma
Adenocarcinoma
Cohort Studies
Retrospective Studies
Prospective Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Performance characteristics of EUS for locoregional evaluation of ampullary lesions. / Ridtitid, Wiriyaporn; Schmidt, Suzette E.; Al-Haddad, Mohammad A.; Leblanc, Julia; DeWitt, John; McHenry, Lee; Fogel, Evan; Watkins, James L.; Lehman, Glen; Sherman, Stuart; Coté, Gregory A.

In: Gastrointestinal Endoscopy, Vol. 81, No. 2, 01.02.2015, p. 380-388.

Research output: Contribution to journalArticle

Ridtitid, Wiriyaporn ; Schmidt, Suzette E. ; Al-Haddad, Mohammad A. ; Leblanc, Julia ; DeWitt, John ; McHenry, Lee ; Fogel, Evan ; Watkins, James L. ; Lehman, Glen ; Sherman, Stuart ; Coté, Gregory A. / Performance characteristics of EUS for locoregional evaluation of ampullary lesions. In: Gastrointestinal Endoscopy. 2015 ; Vol. 81, No. 2. pp. 380-388.
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abstract = "Background The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear. Objectives To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions. Design Retrospective cohort study. Setting Tertiary-care referral center. Patients All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. Intervention EUS. Main Outcome Measurements Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy. Results We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83{\%}) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56{\%}/97{\%} (AUROC = 0.77; 95{\%} confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80{\%}/93{\%}; AUROC = 0.87; 95{\%} CI, 0.76-0.97) and ERCP (83{\%}/93{\%}; AUROC = 0.88; 95{\%} CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90{\%}. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91{\%}); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80{\%}) and 4 of 7 (57{\%}), respectively. Limitation Retrospective design. Conclusions EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection.",
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T1 - Performance characteristics of EUS for locoregional evaluation of ampullary lesions

AU - Ridtitid, Wiriyaporn

AU - Schmidt, Suzette E.

AU - Al-Haddad, Mohammad A.

AU - Leblanc, Julia

AU - DeWitt, John

AU - McHenry, Lee

AU - Fogel, Evan

AU - Watkins, James L.

AU - Lehman, Glen

AU - Sherman, Stuart

AU - Coté, Gregory A.

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N2 - Background The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear. Objectives To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions. Design Retrospective cohort study. Setting Tertiary-care referral center. Patients All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. Intervention EUS. Main Outcome Measurements Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy. Results We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively. Limitation Retrospective design. Conclusions EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection.

AB - Background The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear. Objectives To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions. Design Retrospective cohort study. Setting Tertiary-care referral center. Patients All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. Intervention EUS. Main Outcome Measurements Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy. Results We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively. Limitation Retrospective design. Conclusions EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection.

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