Pathologic Subtypes of Ampullary Adenocarcinoma: Value of Ampullary MDCT for Noninvasive Preoperative Differentiation
| Autor: | Koenraad J. Mortele, Ruzica Maksimovic, A. Ivanovic, Slavenko Ostojic, Marjan Micev, Francesco Alessandrino, Richard M. Gore |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Ampulla of Vater Common Bile Duct Neoplasms Gastroenterology Sensitivity and Specificity 030218 nuclear medicine & medical imaging 03 medical and health sciences symbols.namesake 0302 clinical medicine Internal medicine Multidetector Computed Tomography Preoperative Care Medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Fisher's exact test Aged Neoplasm Staging Aged 80 and over Observer Variation Common bile duct business.industry Reproducibility of Results Ampullary Adenocarcinoma Retrospective cohort study General Medicine Middle Aged medicine.disease medicine.anatomical_structure 030220 oncology & carcinogenesis symbols Adenocarcinoma Female Radiology business |
| Zdroj: | AJR. American journal of roentgenology. 208(3) |
| ISSN: | 1546-3141 |
| Popis: | The purpose of this study was to evaluate the utility of ampullary MDCT in the noninvasive, preoperative differentiation of pancreatobiliary and intestinal subtypes of ampullary adenocarcinoma.This retrospective study included 32 patients (20 men, 12 women; age range, 41-81 years) with resected ampullary adenocarcinoma who underwent preoperative contrast-enhanced ampullary MDCT. Two radiologists, blinded to pathologic diagnosis of adenocarcinoma subtype, evaluated the presence of seven MDCT features independently. MDCT findings and ampullary adenocarcinoma subtypes were correlated using chi-square and Fisher exact tests. Interobserver agreement was evaluated using the Cohen kappa statistic.When evaluated with ampullary MDCT, the intestinal and pancreatobiliary subtypes were significantly different in terms of lesion morphology (p0.0001), papillary shape (p0.0001), common bile duct (CBD) infiltration and dilatation (p = 0.003 and p = 0.0004, respectively), duodenopancreatic groove infiltration (p = 0.0009), and pancreaticoduodenal artery involvement (p = 0.004). Pancreatobiliary subtype tumors were more often infiltrative in morphology (18/18) and showed retracted papilla (14/18), CBD (18/18) and main pancreatic duct (MPD) infiltration (12/18), dilated CBD (18/18) and MPD (13/18), fixed duodenopancreatic groove appearance (15/18), and pancreaticoduodenal artery involvement (12/18). Intestinal subtype carcinomas were more frequently nodular (14/14) and had a bulging papilla (13/14), a free duodenopancreatic groove appearance (11/14), and no pancreaticoduodenal artery involvement (2/14). When all features were taken into account, MDCT showed sensitivity of 85.7% and specificity of 83.3% in differentiating intestinal and pancreatobiliary subtype tumors. Accuracy, positive predictive value, and negative predictive value of MDCT were 84.4%, 80%, and 88.2%, respectively. Interobserver agreement was almost perfect for the presence of each imaging feature (κ0.8).Ampullary MDCT can be useful to differentiate pancreatobiliary and intestinal subtypes of ampullary adenocarcinoma preoperatively, provided the duodenum is optimally distended at imaging. |
| Databáze: | OpenAIRE |
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