title: Usefulness of white-light imaging-guided narrow-band imaging for the differential diagnosis of small ampullary lesions.
abstract: BACKGROUND
  Small ampullary tumors and inflammatory lesions have similar endoscopic findings and are difficult to differentiate. Narrow-band imaging (NBI) can visualize microvessels and mucosal microstructure clearly and is widely used to diagnose early gastric and colon cancer.
  
  
  OBJECTIVE
  To evaluate the usefulness of NBI for differentiating ampullary tumors from benign diseases.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care hospital.
  
  
  METHODS
  All 45 patients who had suspicious ampullary lesions (enlarged or protruded morphology) during duodenoscopy and underwent NBI between March 2010 and January 2011.
  
  
  METHODS
  NBI.
  
  
  METHODS
  NBI images were assessed for irregular villous arrangement, irregular villous size, ridge disappearance, demarcation with normal villi, and abnormal microvasculature. Histology of NBI-guided lesion biopsy specimens provided the final diagnoses. Agreement between NBI images and histologic findings was analyzed.
  
  
  RESULTS
  Of the 60 ampullary lesions, 11, 26, and 23 were adenocarcinomas, adenomas, and benign inflammatory diseases, respectively. Irregular villous arrangement, irregular villous size, ridge disappearance, demarcation with normal villi, and abnormal microvasculature were observed in 45%, 63%, 50%, 48%, and 58% of the lesions, respectively. Multivariate analysis revealed that irregular villous arrangement (odds ratio [OR] 15.76; 95% confidence interval [CI], 3.38-64.12; P < .001) and abnormal microvasculature (OR 86.63; 95% CI, 14.56-515.41; P < .001) were significant independent factors for identifying ampullary adenomas and adenocarcinoma. All tumors had at least one abnormal NBI feature.
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  The NBI findings of irregular villous arrangement and/or abnormal microvasculature were useful for differentially diagnosing ampullary tumors. NBI may complement the accurate diagnosis of ampullary lesions by white-light imaging.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002761:Cholangitis / Q000175:diagnosis*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods*; D011230:Precancerous Conditions / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity