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

Öz

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

Abstract

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

Kaynakça

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