The diagnostic value of papilla biopsy

Year 2015, Volume: 23 Issue: 2, 35 - 39, 29.08.2015

Ali Rıza Köksal Hüseyin Alkım , Salih Boğa İlker Şen Mehmet Bayram Özgür Bostancı Banu Yılmaz Özgüven Canan Alkım

https://doi.org/10.17940/endoskopi.467392

Abstract

Background and Aims:Biopsy of the papilla taken during ERCP is widely used in the diagnosis of periampullary tumors. In this study, we aimed to evaluate the biopsy results taken from the papilla with the suspicion of tumor. and determine their predictive value after confirming the final the diagnosis. Materials and Methods:A total of 48 patients whom biopsies were taken from papilla during ERCP done between January 2013 and December 2014 in our clinic were taken to the study. ERCP and pathology reports, post-ERCP operative/EUS/or other guided biopsy results were collected retrospectively from computer database. According to these results final diagnosis of the patients were determined. Results:The mean age ot the patients was 69.4±13.3 years. Twenty-two of the cases wer male and 26 were female. According to the pathology reports in 12 (25%) of the patients malignancy were positive, in 7 (14.6%) of the patients adenomatous changes were present, in 23 (47.9%) of the patients malignancy were negative and in 6 of the patients the distinction between malign or benign changes could not be done. With these biopsy results 6 patients underwent to Whipple operation and ampullectomy was done in 1 patient. According to final diagnosis 19 (39.6%) of the patients were found malign, 5 (10.4%) of the patients were found to have adenomas and the remaining 24 (50%)patients were found negative for malignancy. The sensitivity of the biopsy of papilla for prediciting malignancy was found 66.6% and specificity was 100%, PPV was 100%, NPV 80% and diagnostic accuracy was 85%. In the malignancy positive group, pre-procedural ALP, ALT, AST, total bilirubin and CA 19-9 levels and number of the biopsies were found statistically significantly higher. In 3 patients with malignancy negative or indiscriminant biopsy results final diagnosis were obtained with second biopsy of the papilla. One of these patients were found to have adenocarcinoma. Conclusion:In patients with suspicion of ampullary region tumors the contribution of the biopsy of the papilla to the diagnosis was significant. Even if the first biopsy was negative, in the presence of clinical suspicion, the second biopsy may be helpful for definitive diagnosis. Papilla biopsy should be performed especially in patients with elevated AST, ALT, ALP, total bilirubin and CA 19-9 levels when there is clinical suspicion of malignancy.

Keywords

Peri-ampullary tumor, biopsy of the papilla, obstructive jaundice

Papilla biyopsisinin tanısal değeri

Abstract

Giriş ve Amaç:Endoskopik retrograd koloanjiopankreatografi esnasında alınan papilla biyopsisi periampuller bölge tümörlerinin tanısında yaygın olarak kullanılmaktadır. Bu çalışmada, tümörden şüphelenilen olgularda alı-nan papilla biyopsi sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem:Çalışmaya kliniğimizde Ocak 2013 ile Aralık 2014 tarihleri arasında yapılan endoskopik retrograd kolanjiopankreatografi sırasında papilladan biyopsi alınan toplam 48 vaka alındı. Endoskopik retrograd kolanjiopankreatografi ve patoloji raporları, endoskopik retrograd kolanjiopankreatografi sonrası ameliyat/görüntüleme/endoskopik ultrasonografi eşliğinde biyopsi bulguları, bilgisayar veri tabanından retrospektif olarak toplandı. Bu sonuçlara göre hastaların nihai tanıları tespit edildi. Bulgular:Hastaların ortalama yaşı 69.4±13.3 yıl idi. Vakaların 22’si erkek, 26’si kadındı. Patoloji sonuçları-na göre hastaların 12’si (%25) malignite pozitifti, 7’sinde (%14.6) adenomatöz değişiklikler saptanmıştı, 23’ünde (%47.9) malignite negatifti ve 6’sında (%12.5) malign/benign ayrımı yapılamamıştı. Papilla biyopsisi sonuçlarına göre 1 hastaya ampullektomi ve 6 hastaya Whipple operasyonu uygulandı. Nihai tanılara göre hastaların 19’unun (%39.6) malign, 5’inin (%10.4) adenom, 24’ünün (%50) malignite negatif olduğuna karar verildi. Papilla biyopsisinin malignite tanısını öngörmede sensitivitesi %66.6, spesifitesi %100, pozitif prediktif değer %100, negatif prediktif değer %80 ve tanısal doğruluk oranı %85 olarak bulundu. İşlem öncesi alkalen fosfataz, aspartat aminotransferaz, alanin aminotransferaz, total bilirubin ve CA 19-9 düzeyleri ve işlem sırasında alınan parça sayısı malign grupta istatistiksel olarak anlamlı biçimde yüksekti. İlk biyopsileri negatif veya ayrım yapılamayan şeklinde rapor edilen ve papilla biyopsisi tekrarlanan 3 olguda da ikinci biyopsi ile nihai tanıya ulaşıldı. Bu olgulardan biri adenokarsinomdu. Sonuç:Ampüller bölge tümörü düşünülen olgularda papilla biyopsisinin tanıya katkısı yüksektir. İlk biyopsi negatif gelse de klinik bulgular varsa, ikinci biyopsinin yapılması yararlı olabilir. Özellikle aspartat aminotransferaz, alanin aminotransferaz, alkalen fosfataz, total bilirubin ve CA 19-9 değerleri yüksek olgularda klinik şüphe varlığında biyopsi yapılmalıdır.

Keywords

Periampuller tümör, papilla biyopsisi, tıkanma ikter

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