title: Performance characteristics of EUS for locoregional evaluation of ampullary lesions.
abstract: BACKGROUND
  The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear.
  
  
  OBJECTIVE
  To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012.
  
  
  METHODS
  EUS.
  
  
  METHODS
  Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy.
  
  
  RESULTS
  We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively.
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA; Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Wiriyaporn
authors.initials: W
authors.lastname: Ridtitid
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Suzette E
authors.initials: SE
authors.lastname: Schmidt
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Al-Haddad
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: LeBlanc
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Coté
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies