title: Endoscopic ultrasound assessment of lesions of the ampulla of Vater is of particular value in low-grade dysplasia.
abstract: BACKGROUND
  The accurate diagnosis of dysplasia or carcinoma within ampullary lesions can be difficult, but, when possible, identifies patients who require endoscopic or surgical resection, respectively. The role of endoscopic ultrasound (EUS) in diagnosing these lesions and the degree of dysplasia is unclear.
  
  
  METHODS
  Patients with lesions of the ampulla were identified over 5 years. Patients who did not undergo EUS were compared with those who did.
  
  
  RESULTS
  A total of 27 of 58 (47%) patients were investigated with EUS. Pretreatment diagnoses were correct in 93% of the EUS group vs. 78% of the no-EUS group. Rates of diagnostic accuracy in low-grade dysplasia (LGD), high-grade dysplasia (HGD) and adenocarcinoma (ADC) were 72%, 20% and 96%, respectively, in the no-EUS group, and 93%, 50% and 100%, respectively, in the EUS group. Every diagnosis of LGD in the EUS group was correct, whereas these diagnoses accounted for the majority of errors (eight of 13) in the no-EUS group. High-grade dysplasia was frequently misdiagnosed. More patients were treated by endoscopic resection in the EUS group (12 of 27 vs. five of 31; P= 0.025).
  
  
  CONCLUSIONS
  Endoscopic ultrasound increases the accuracy of preoperative diagnosis of ampullary lesions and is particularly useful in patients with LGD because it permits safe endoscopic management. Patients with HGD must be reviewed carefully and considered for pancreatoduodenectomy.
authors.affiliation: The Liver Unit, University Hospitals Birmingham, UK. j.k.roberts@bham.ac.uk
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: Neil
authors.initials: N
authors.lastname: McCulloch
authors.forename: Rob
authors.initials: R
authors.lastname: Sutcliffe
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Simon
authors.initials: S
authors.lastname: Bramhall
authors.forename: Darius
authors.initials: D
authors.lastname: Mirza
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: Brinder S
authors.initials: BS
authors.lastname: Mahon
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003951:Diagnostic Errors; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D055815:Young Adult