Ufuk Barış KUZU, Bülent ÖDEMİŞ, Erkan PARLAK, Selçuk DİŞİBEYAZ, Mustafa KAPLAN, Zeliha SIRTAŞ, Hakan YILDIZ, Nuretdin SUNA, Erkin ÖZTAŞ, Vedat ERKAN, Orhan COŞKUN, Ertuğrul KAYAÇETİN

Periampüller bölge tümörlerinin tanısında papil biyopsisi ve endoskopik görünümün rolü: tek merkez deneyimi

Giriş ve Amaç: Periampuller bölge tümörleri tüm gastrointestinal malignensilerin yaklaşık %0,5-2’sini oluşturmaktadır. Bu tümörler arasında en sık olarak pankreas başı ve ampulla vateri kanseri görülmektedir. Bu tümörlerin erken tanısı ve benign lezyonlardan ayırımı tedavi şeklinin belirlenmesinde önem taşımaktadır. Çalışmamızın amacı, papiller forseps biyopsinin pankreas tümürü ve ampulla vateri tümörü tanısında etkinliğinin değerlendirilmesi ve iki tümöre ait özelliklerin karşılaştırılmasıdır. Gereç ve Yöntem: Çalışma Türkiye Yüksek İhtisas Hastanesi endoskopik retrograd kolanjiopankreatografi ünitesinde 7 yıllık periyotta endoskopik retrograd kolanjiopankreatografi yapılan ve papiller forseps biyopsisi alınan hastalar geriye yönelik tarandı. Bulgular: Çalışmaya toplam 135 hasta dahil edildi. Toplam 58 (%50) hastada malignite tespit edildi. En sık saptanan malign tümörler ampulla vateri kanseri ve pankreas başı kanseri idi [sırası ile hastaların %28.4 (n=33) ve %12.1 (n=14)]. Papiller forseps biyopsinin periampuller bölge tümörü tanısında spesifitesi %96.7 ve sensitivitesi %72.4 ölçüldü. Papilin endoskopik görünümüne göre endoskopistin yorumunun periampuller bölge tümörü tanısında sensitivitesi %64.3 olarak ölçüldü. Pankreas başı kanseri ile ampulla vateri kanseri arasında hastaların verileri iki kanser grubu arasında karşılaş- tırıldığında sadece CA-19.9 değerleri iki grup arasında farklıydı (sırası ile 365 U/ml ve 78 U/ml; p=0.01). Sonuç: Periampuller bölge tümörleri’nin ayırıcı tanısında duedonoskop eşliğinde gerçekleştirilen papiller forseps biyopsisi oldukça yararlı bir yöntemdir. Ek olarak malign hastaların ayırımında papilin endoskopi görünümünün değerlendirilmesi ve tümör markırlarının kullanımı ile bu yöntemin etkinliği daha da arttırılabilir.

Anahtar Kelimeler:

Papiller forseps biyopsisi

Role of endoscopic biopsy and endoscopic view in diagnosis of periampullary area tumors

Background and Aims: Periampullary area tumors account for about 0.5- 2% of all gastrointestinal malignancies. Malignant tumors of pancreatic head and ampulla vater are the most seen tumors of this region. The early diagnosis of these tumors and separation from benign lesions are important in choosing a treatment modality. The aim of our study is to evaluate the activity of papillary forceps biopsy in the diagnosis of pancreatic and ampulla vater tumors, and to compare the two tumors’ properties. Materials and Methods: Patients in whom papillary forceps biopsy was performed were screened retrospectively in the endoscopic retrograde cholangiopancreatography unit of Türkiye Yüksek İhtisas Hospital within 7-year period. Results: A total of 135 patients were included in the study. Malignancy was detected in 50% of patients (n=58). The most frequent malignant tumors were ampulla vater cancer and pancreatic cancer [28.4% of patients (n=33); and 12.1% (n=14), respectively]. The specificity of papillary forceps biopsy in the diagnosis of periampullary area tumors was found to be 96.7%, and sensitivity was 72.4%. When the endoscopist view was evaluated according to the papillary endoscopic appearance, sensitivity was measured as 64.3%. Only CA-19-9 levels were statistically different between pancreatic head cancer and ampulla vater cancer groups (365 U/ml and 78 U/mL, respectively; p = 0.01). Conclusion: Papillary forceps biopsy performed with duodonoscopy is a useful method in the differential diagnosis of periampullary tumors. This method can be further improved by the evaluation of endoscopic apparance of papillae and additionally by using tumor markers.

Keywords:

periampullary tumors Papillary forceps biopsy,

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KAYNAKLAR 1. Uomo G. Periampullary carcinoma: some important news in histopathology. JOP 2014;15:213-5. 2. Berberat PO, Kunzli BM, Gubinas A, et al. An audit of outcomes of a series of periampullary carcinomas. Eur J Surg Oncol 2009;35:187-91. 3. Beger HG, Treitschke F, Gansauge F, et al. Tumor of the ampulla of Vater: Experience with local or radical resection in 171 consecutively treated patients. Arch Surg 1999;134:526-32. 4. Hutchins R, Williamson RCN. Periampullary Cancer. Medicine. 2003;31(3): 126-7. 5. Leese T, Neoptolemos JP, West KP, et al. Tumours and pseudotumours of the region of the ampulla of Vater: an endoscopic, clinical and pathological study. Gut 1986;27:1186-92. 6. Warshaw AL. Implications of peritoneal cytology for staging early pancreatic cancer. Am J Surg 1991;161:26-9. 7. Barish MA, Yucel EK, Ferrucci JT. Magnetic resonance cholangiopancreatography. N Engl J Med 1999;341:258-64. 8. Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health Stateof-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002. Gastrointest Endosc 2002;56:803-9. 9. Griffanti-Bartoli F, Arnone GB, Ceppa P, et al. Malignant tumors in the head of the pancreas and the periampullary region. Diagnostic and prognostic aspects. Anticancer Res. 1994;14:657-66. 10. Sugiyama M, Atomi Y, Wada N, et al. Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol 1996;91:465-7. 11. Pugliese V, Conio M, Nicolò G, et al. Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study. Gastrointest Endosc 1995;42:520-6. 12. DeOliveira ML, Triviño T, de Jesus Lopes Filho G. Carcinoma of the papilla of Vater: are endoscopic appearance and endoscopic biopsy discordant? J Gastrointest Surg 2006;10:1140-3. 13. Menzel J, Poremba C, Dietl KH, et al. Tumors of the papilla of Vater--inadequate diagnostic impact of endoscopic forseps biopsies taken prior to and following sphincterotomy. Ann Oncol 1999;10:1227-31. 14. Ross WA, Bismar MM. Evaluation and management of periampullary tumors. Curr Gastroenterol Rep 2004;6:362-70. 15. Sakorafas GH, Friess H, Balsiger BM, et al. Problems of reconstruction during pancreatoduodenectomy. Dig Surg 2001;18:363-9. 16. Schima W, Ba-Ssalamah A, Kolblinger C, et al. Pancreatic adenocarcinoma. Eur Radiol 2007;17:638-49. 17. Jemal A, Siegel R, Ward E, et al. Cancer statistics, CA Cancer J Clin 2008;58:71-96. 18. Kuzu UB, Ödemiş B, Turhan N, et al. The diagnostic value of brush cytology alone and in combination with tumor markers in pancreaticobiliary strictures. Gastroenterol Res Pract 2015;2015:580254. 19. Cwik G, Wallner G, Skoczylas T, et al. Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions. Arch Surg 2006;141:968-74. 20. Morris-Stiff G, Teli M, Jardine N, Puntis MC. CA19-9 antigen levels can distinguish between benign and malignant pancreaticobiliary disease. Hepatobiliary Pancreat Dis Int 2009;8:620-6. 21. Koprowski H, Steplewski Z, Mitchell K, et al. Colorectal carcinoma antigens detected by hybridoma antibodies. Somatic Cell Genet 1979;5:957- 71. 22. Alexakis N, Gomatos IP, Sbarounis S, et al. High serum CA 19-9 but not tumor size should select patients for staging laparoscopy in radiological resectable pancreas head and peri-ampullary cancer. Eur J Surg Oncol 2015;41:265-9. 23. Böttger T, Hassdenteufel A, Boddin J, et al. Value of the CA 19-9 tumor marker in differential diagnosis of space-occupying lesions in the head of the pancreas. Chirurg 1996;67:1007-11.