title: Comparative yield of fine needle aspiration cytology, ampullary biopsy, and needle knife assisted biopsy in the diagnosis of nonulcerated periampullary tumors.
abstract: OBJECTIVE
  Periampullary tumors (PAT) are defined as tumors arising within 2 cm of the major duodenal papilla. Studies on yield of preoperative biopsy for nonulcerated PAT are scarce. Needle knife papillotomy-assisted biopsy (NKAB) may sample the deeper tissues and thereby increase the histologic yield. We aimed to compare the diagnostic yield of fine needle aspiration cytology (FNAC), surface ampullary biopsy, and NKAB in nonulcerated PAT.
  
  
  METHODS
  Patients with suspected PAT based on clinical, biochemical, and radiologic investigations were evaluated. Patients with smooth ampullary bulge on side viewing endoscopy (SVE) were included, while those with gastric outlet obstruction or obvious ulceration of ampulla on SVE were excluded.
  
  
  RESULTS
  Twenty-five of 78 patients with PAT met the inclusion criteria. The median (range) age was 60 (43-75) years, and 13 were male. Serum CA 19.9 was 466 (2-9372) U/mL. Histopathological positivity rate for surface biopsy, FNAC, and NKAB was 10 (40 % and 95 % CI: 21.8 % to 61.1 %), 12 (48 % and 95 % CI: 28.3 % to 68.2 %), and 21 (84 % and 95 % CI: 63.1 % to 94.7 %), respectively. Diagnostic yield of NKAB was significantly better than surface biopsy (p = 0.001) and FNAC (p = 0.007). None of the patients subjected to NKAB had any complications other than self-limited minor ooze.
  
  
  CONCLUSIONS
  NKAB was superior to surface biopsy or FNAC to establish preoperative tissue diagnosis of nonulcerated PAT. NKAB is safe and simple in expert hands and may be recommended as standard procedure to obtain histological specimen in these patients.
authors.affiliation: Department of Gastroenterology, G B Pant Hospital, J L Nehru Marg, New Delhi 110 002, India.
authors.forename: Ram Chandra
authors.initials: RC
authors.lastname: Soni
authors.forename: Amarender Singh
authors.initials: AS
authors.lastname: Puri
authors.forename: Vishal
authors.initials: V
authors.lastname: Garg
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
authors.forename: Ameet
authors.initials: A
authors.lastname: Banka
authors.forename: Pankaj
authors.initials: P
authors.lastname: Tyagi
authors.forename: Ravinder Kumar
authors.initials: RK
authors.lastname: Saran
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D044963:Biopsy, Fine-Needle / Q000379:methods; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results