• Anouk J de Wilde, Evelien J M de Jong, Kurinchi S Gurusamy, Mohammad Abu Hilal, Marc G Besselink, Maxime J L Dewulf, Sandra M E Geurts, Ulf P Neumann, Olde DaminkSteven W MSWMDepartment of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands., Jan-Werner Poley, Tjan-HeijnenVivianne C GVCGDepartment of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Centre+, GROW, Maastricht University, Maastricht, the Netherlands., Judith de Vos-Geelen, Georg Wiltberger, CoolsenMariëlle M EMMEDepartment of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands., and BouwenseStefan A WSAW0000-0002-7600-9429Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands..
• Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
• Br J Surg. 2024 Jan 3; 111 (1).

BackgroundDifferentiation between adenomas and carcinomas of the ampulla of Vater is crucial for therapy and prognosis. This was a systematic review of the literature on the accuracy of diagnostic modalities used to differentiate between benign and malignant ampullary tumours.MethodsA literature search was conducted in PubMed, Embase, CINAHL, and the Cochrane Library. Studies were included if they reported diagnostic test accuracy information among benign and malignant ampullary tumours, and used pathological diagnosis as the reference standard. Risk of bias was assessed using Quality Assessment on Diagnostic Accuracy Studies (QUADAS) 2 and QUADAS-C.ResultsTen studies comprising 397 patients were included. Frequently studied modalities were (CT; 2 studies), endoscopic ultrasonography (EUS; 3 studies), intraductal ultrasonography (IDUS; 2 studies), and endoscopic forceps biopsy (3 studies). For CT, the reported sensitivity for detecting ampullary carcinoma was 44 and 95%, and the specificity 58 and 60%. For EUS, the sensitivity ranged from 63 to 89% and the specificity between 50 and 100%. A sensitivity of 88 and 100% was reported for IDUS, with a specificity of 75 and 93%. For forceps biopsy, the sensitivity ranged from 20 to 91%, and the specificity from 75 to 86%. The overall risk of bias was scored as moderate to poor. Data were insufficient for meta-analysis.ConclusionTo differentiate benign from malignant ampullary tumours, EUS and IDUS seem to be the best diagnostic modalities. Sufficient high-quality evidence, however, is lacking.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

6 keywords...

hide…