Diagnostic Utility of Clinical, Biochemical, Radiological and Preoperative Biopsy in Ampullary and Periampullary Lesions
Praneetha Modumudi, B. V Dinesh, Shiran Shetty
A
BSTRACT
Background:
Despite advancements in diagnostic techniques, the relative utility and accuracy of ideal tools in predicting ampullary and periampullary lesions remain unclear. This study evaluates the clinical, biochemical, radiological, and preoperative biopsy parameters in comparison to histopathological examination (HPE) of the gross specimen in predicting the malignancy in these lesions.
Materials and Methods:
This prospective observational study included 30 patients who underwent pancreaticoduodenectomy for ampullary and periampullary lesions. Clinical, biochemical, radiological, and preoperative biopsy (endoscopic ultrasound-guided fine-needle aspiration cytology [EU-FNAC] findings were documented. The results of all parameters were compared with the final HPE findings to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Results:
The mean age of the patients with ampullary and periampullary lesions was 58.83 ± 9.68 years with male predominance (63.3%). Weight loss (73.3%) was the most common clinical feature among patients. Elevated biochemical parameters—direct bilirubin (60%), total bilirubin (86.7%), and carbohydrate antigen (CA 19-9) (73.3%)—were observed in most patients. Contrast-enhanced computed tomography of the abdomen identified periampullary lesions in 76.7% of patients. Among the patients who underwent EUS-FNAC, adenocarcinoma grades 1 and 2 was found in nearly half of them (43.4%). The findings were significantly associated with the final HPE in identifying malignant lesions (83.3%) and non-malignant lesions (100.0%;
Conclusion:
Compared to clinical, biochemical, and radiological parameters, EUS-FNAC is a reliable tool for diagnosing ampullary and periampullary lesions, closely aligning with histopathological results.