title: The diagnostic accuracy and strength of agreement between endoscopic ultrasound and histopathology in the staging of ampullary tumors.
abstract: OBJECTIVE
  Ampullary tumors are rare. Reports on ampullary tumor staging are heterogeneous and combine both periampullary and ampullary tumors. This study assessed the performance of endoscopic ultrasound (EUS) in the local staging of ampullary tumors only.
  
  
  METHODS
  Data were collected retrospectively. We included patients with an ampullary tumor who underwent EUS and surgical resection. Tumor (T) and nodal (N) TNM staging for EUS and histopathological (HP) staging were compared.
  
  
  RESULTS
  From 2009 to 2010, a total of 79 patients with ampullary tumors were identified. Of these, 26 had both EUS and Whipple's surgery and were included (28 did not undergo resection, 13 had palliative surgery only and 12 had resection without EUS). For T staging by HP, there were 2 (7.7 %) T1, 11 (42.3 %) T2, 12 (46.2 %) T3 and 1 (3.8 %) T4 tumors. The accuracy of EUS T staging was 73.1 % with a Kappa value of 0.564 (p < 0.0001). The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) of EUS, respectively were 50.0 %, 91.7 %, 33.3 % and 95.7 % for T1 tumors; 81.8 %, 80.0 %, 75.0 % and 85.7 % for T2; 75.0 %, 92.9 %, 90.0 % and 81.3 % for T3 tumors. For N staging by HP, 17 (65.4 %) were N0 and 9 (34.6 %) N1. The N staging diagnostic accuracy was 80.8 % with a Kappa value of 0.586 (p = 0.003). The sensitivity, specificity, PPV, NPV for N0 disease were 82.4 %, 77.8 %, 87.5 % and 70.0 %, respectively while for N1 they were 77.8 %, 82.4 %, 70.0 % and 87.5 %, respectively.
  
  
  CONCLUSIONS
  EUS had a moderate strength of agreement with histopathology for both T and N staging, and a high diagnostic accuracy for nodal staging.
authors.affiliation: Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500 082, Andhra Pradesh, India.
authors.forename: Eric
authors.initials: E
authors.lastname: Wee
authors.forename: Sandeep
authors.initials: S
authors.lastname: Lakhtakia
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Sekaran
authors.initials: S
authors.lastname: Anuradha
authors.forename: Mahesh
authors.initials: M
authors.lastname: Shetty
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kalapala
authors.forename: Amitabh
authors.initials: A
authors.lastname: Monga
authors.forename: Arjunan
authors.initials: A
authors.lastname: Saravanan
authors.forename: Pradeep
authors.initials: P
authors.lastname: Rebala
authors.forename: Mohan
authors.initials: M
authors.lastname: Ramchandani
authors.forename: Guduru Venkat
authors.initials: GV
authors.lastname: Rao
authors.forename: Duvvuru Nageshwar
authors.initials: DN
authors.lastname: Reddy
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D000328:Adult; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies