title: Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas.
abstract: OBJECTIVE
  To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).
  
  
  METHODS
  Clinicopathological data were reviewed for 84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September 2002 and August 2014 at a single prefectural cancer center. Superficial NADETs were defined as lesions confined to the mucosa or submucosa. Demographic and clinicopathological data were retrieved from charts, endoscopic and pathologic reports. Endoscopic reports included endoscopic diagnosis, location, gross type, diameter, color, and presence or absence of biopsy. Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained. Endoscopic images were obtained using routine, front-view, high-resolution video endoscopy, and chromoendoscopy with indigocarmine was performed for all lesions. Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma. Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens. Sensitivity, specificity, and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.
  
  
  RESULTS
  The majority (81%) of the lesions were located in the second portion of the duodenum. The median lesion diameter was 14.5 mm according to final histology. Surgery was performed for 49 lesions from 39 patients, and 35 lesions from 35 patients were endoscopically resected. Final histology confirmed 65 carcinomas, 15 adenomas, and 3 hyperplasias. A final diagnosis of duodenal carcinoma was made for 91% (52/57) of the lesions diagnosed as carcinoma by endoscopy and 93% (42/45) of the lesions diagnosed as carcinoma by biopsy. The sensitivity, specificity, and accuracy of endoscopic diagnoses were 80%, 72%, and 78%, respectively, whereas those of biopsy diagnoses were 72%, 80%, and 74%, respectively. Preoperative diagnoses of carcinomas were made in 88% (57/65) of the carcinoma lesions via endoscopy or biopsy. Endoscopic findings associated with carcinoma were red color, depression, and mixed-type morphology.
  
  
  CONCLUSIONS
  Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kanemoto
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Kawata
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Takizawa
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Imai
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Kinichi
authors.initials: K
authors.lastname: Hotta
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.affiliation: Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004396:Coloring Agents; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D004384:Duodenoscopy / Q000379:methods; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007203:Indigo Carmine; D007564:Japan; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014741:Video Recording
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine
keywords: Biopsy; Duodenal adenoma; Duodenal carcinoma; Duodenal neoplasms; Endoscopic diagnosis