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Abstract

Background: Endoscopy from a suspected ampulla of vator may establish an early preoperative diagnosis of ampullary carcinoma. However, information regarding the diagnostic accuracy of this procedure is limited and variable. The purpose of this study was to find the incidence of ampullary carcinoma in Dhulikhel Hospital and to assess the preoperative diagnostic accuracy of Endoscopic/ERCP appearance and endoscopic biopsy in all cases with suspicion of tumor. Materials and Methods: Among patients who were performed endoscopy during a one year period; a suspicious ampulla of vator was seen in 44 cases. Endoscopic biopsy specimens were classified into four groups based on the degree of epithelial atypia: group 1 (no evidence of malignancy), group 2 (presence of dysplasia), group 3 (suspicious of malignancy) and group 4 (positive for malignancy). In each case comparison was made between the pre-endoscopic biopsy clinical diagnosis and endoscopic appearance. Results: Endoscopic biopsy diagnosis of malignancy (Group 4) were seen in 22 cases, Suspicious of malignancy (group3) in 3 cases, Dysplasia (Group 2) in 9 cases and no evidence of malignancy (Group 1) in 10 cases. Pre-endoscopic diagnostic accuracy of endoscopy/ ERCP was 50% compared to the diagnosis by biopsy. Conclusions: The accuracy of clinical diagnosis and endoscopy is limited. This limitation must be considered when evaluating the optimal management of patients with suspected ampullary tumor.

Biography

Dhakal Binod is a Pathologist at Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal