title: New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system.
abstract: BACKGROUND
  A newly developed narrow-band imaging (NBI) system, which uses modified optical filters, can yield clear images of microvessels and surface structure in gastric and colonic diseases. In the present study, we investigated the ability of magnifying endoscopy with NBI (MENBI) to diagnose and differentiate between benign and malignant ampullary tumors.
  
  
  METHODS
  Fourteen patients, whose ampullas were noted to be significantly enlarged or protruding with conventional endoscopy, were enrolled in the study. Specimens, which were obtained by forceps biopsy, endoscopic papillectomy, and/or surgery, were retrieved for histopathological examination. The correlation between MENBI images and histopathological findings was investigated. MENBI findings were classified as I, oval-shaped villi; II, pinecone/leaf-shaped villi; or III, irregular/nonstructured. In addition, tortuous, dilated, and network-like vessels noted on the ampullary lesions with MENBI were defined as abnormal vessels.
  
  
  RESULTS
  In 6 of 14 patients, the ampullary changes were proven to be inflammatory in forceps biopsy specimens, without any evidence of malignancy after more than 1 year of follow-up. In five patients, ampullary lesions were treated by endoscopic papillectomy, and in three, by pancreatoduodenectomy. All adenomas and adenocarcinomas had type II and/or type III surface structures, and patients whose ampulla had a type I surface structure had only inflammatory or hyperplastic changes. In addition, abnormal vessels were seen only in adenocarcinomas and never in adenomas.
  
  
  CONCLUSIONS
  MENBI has the ability and potential to predict histological characteristics of ampullary lesions.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: Hiroo
authors.initials: H
authors.lastname: Imazu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kakutani
authors.forename: Shoryoku
authors.initials: S
authors.lastname: Hino
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.forename: Akira
authors.initials: A
authors.lastname: Kuramochi
authors.forename: Shintaro
authors.initials: S
authors.lastname: Tsukinaga
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsunaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakayoshi
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Goda
authors.forename: Shoichi
authors.initials: S
authors.lastname: Saito
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.forename: Muneo
authors.initials: M
authors.lastname: Kawamuara
authors.forename: Salem
authors.initials: S
authors.lastname: Omar
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D004379:Duodenal Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation; D008297:Male; D018715:Microscopy, Video; D008875:Middle Aged; D012189:Retrospective Studies