title: Are a Double Duct Sign or Endoscopic Biopsies Reliable Predictors of Malignancy in Periampullary Lesions.
abstract: OBJECTIVE
  To determine the predictive value of a double duct sign (DDS) and endoscopic biopsies to differentiate invasive carcinoma from premalignant lesions.
  
  
  METHODS
  Two hundred and forty one patients (mean age 65.8; male 55.6%) diagnosed with a periampullary lesion from January 1987 through March 2013 were reviewed retrospectively with regard to background characteristics, histology of endoscopic biopsy, diameter of both common bile duct (CBD) and main pancreatic duct (PD), bilirubin levels and final diagnosis.
  
  
  RESULTS
  DDS predicted malignancy with 73% specificity and 72% sensitivity. Endoscopic biopsies predicted malignancy with 96% specificity, 71% sensitivity and a negative predictive value (NPV) of 51%. Multivariable logistic regression analysis showed that DDS is a significant predictor for the presence of malignancy with an odds ratio of 6.37 adjusted to age, gender and endoscopic biopsy.
  
  
  CONCLUSIONS
  Although DDS is indicative of malignancy in periampullary lesions, its clinical use is limited, given the low sensitivity and specificity. The diagnostic value of endoscopic biopsies is also poor due to a low sensitivity and NPV. If a double duct sign is present, physicians must be aware of an increased possibility of a malignant underlying cause, even if the histopathological examination of the biopsies did not show invasive malignancy.
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Josianne C E M
authors.initials: JC
authors.lastname: Ten Berge
authors.forename: Mustafa
authors.initials: M
authors.lastname: Suker
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: Roy
authors.initials: R
authors.lastname: Dwarkasing
authors.forename: Katharina
authors.initials: K
authors.lastname: Biermann
authors.forename: Casper H J
authors.initials: CH
authors.lastname: van Eijck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology*; D001706:Biopsy; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity