The use of endoscopic ultrasonography in the diagnosis and staging of carcinoma of the papilla of Vater.

Abstract

Endoscopic ultrasonography (EUS) was evaluated in the diagnosis of carcinoma of the papilla of Vater. Thirteen cases of carcinoma of the papilla examined by EUS were investigated with the aim of assessing the detection capability of EUS in comparison with other diagnostic tools, and its usefulness in diagnosing the extent of the tumor. The EUS image of the normal papilla of Vater presents as a round protruded region with the layered structure of the duodenal papilla along with images of periampullary organs. All but one of 13 tumors of the duodenal papilla presented as a hypoechoic solid mass at EUS. On the basis of an analysis of the layered structure of the papilla of Vater and/or the duodenal wall, EUS images of 12 cases of ampullary carcinoma confirmed histologically were analysed. The EUS images of the tumors of the duodenal papilla corresponded well with the histological findings. When the extent of carcinoma was classified in 4 stages by EUS, the accuracy rate was 83%. EUS is one of the most promising procedures for determining the extent of tumors of the duodenal papilla.