Periampüller bölge tümörlerinin tanısında papil biyopsisi ve endoskopik görünümün rolü: tek merkez deneyimi

Yıl 2015, Cilt: 23 Sayı: 3, 77 - 81, 25.12.2015

Ufuk Barış Kuzu , Bülent Ödemiş Erkan Parlak , Selçuk Dişibeyaz , Mustafa Kaplan , Zeliha Sırtaş Hakan Yıldız , Nuretdin Suna Erkin Öztaş , Vedat Erkan Orhan Coşkun Ertuğrul Kayaçetin

https://doi.org/10.17940/endoskopi.371243

Öz

Giriş ve Amaç: Periampuller bölge tümörleri tüm gastrointestinal malignensilerin
yaklaşık %0,5-2’sini oluşturmaktadır. Bu tümörler arasında en sık
olarak pankreas başı ve ampulla vateri kanseri görülmektedir. Bu tümörlerin
erken tanısı ve benign lezyonlardan ayırımı tedavi şeklinin belirlenmesinde
önem taşımaktadır. Çalışmamızın amacı, papiller forseps biyopsinin pankreas
tümürü ve ampulla vateri tümörü tanısında etkinliğinin değerlendirilmesi
ve iki tümöre ait özelliklerin karşılaştırılmasıdır. Gereç ve Yöntem: Çalışma
Türkiye Yüksek İhtisas Hastanesi endoskopik retrograd kolanjiopankreatografi
ünitesinde 7 yıllık periyotta endoskopik retrograd kolanjiopankreatografi
yapılan ve papiller forseps biyopsisi alınan hastalar geriye yönelik tarandı.
Bulgular: Çalışmaya toplam 135 hasta dahil edildi. Toplam 58 (%50) hastada
malignite tespit edildi. En sık saptanan malign tümörler ampulla vateri
kanseri ve pankreas başı kanseri idi [sırası ile hastaların %28.4 (n=33) ve
%12.1 (n=14)]. Papiller forseps biyopsinin periampuller bölge tümörü tanısında
spesifitesi %96.7 ve sensitivitesi %72.4 ölçüldü. Papilin endoskopik
görünümüne göre endoskopistin yorumunun periampuller bölge tümörü tanısında
sensitivitesi %64.3 olarak ölçüldü. Pankreas başı kanseri ile ampulla
vateri kanseri arasında hastaların verileri iki kanser grubu arasında karşılaş-
tırıldığında sadece CA-19.9 değerleri iki grup arasında farklıydı (sırası ile
365 U/ml ve 78 U/ml; p=0.01). Sonuç: Periampuller bölge tümörleri’nin
ayırıcı tanısında duedonoskop eşliğinde gerçekleştirilen papiller forseps biyopsisi
oldukça yararlı bir yöntemdir. Ek olarak malign hastaların ayırımında
papilin endoskopi görünümünün değerlendirilmesi ve tümör markırlarının
kullanımı ile bu yöntemin etkinliği daha da arttırılabilir.

Anahtar Kelimeler

Papiller forseps biyopsisi

Role of endoscopic biopsy and endoscopic view in diagnosis of periampullary area tumors

Öz

Background and Aims: Periampullary area tumors account for about 0.5-
2% of all gastrointestinal malignancies. Malignant tumors of pancreatic head
and ampulla vater are the most seen tumors of this region. The early diagnosis
of these tumors and separation from benign lesions are important
in choosing a treatment modality. The aim of our study is to evaluate the
activity of papillary forceps biopsy in the diagnosis of pancreatic and ampulla
vater tumors, and to compare the two tumors’ properties. Materials and
Methods: Patients in whom papillary forceps biopsy was performed were
screened retrospectively in the endoscopic retrograde cholangiopancreatography
unit of Türkiye Yüksek İhtisas Hospital within 7-year period. Results:
A total of 135 patients were included in the study. Malignancy was detected
in 50% of patients (n=58). The most frequent malignant tumors were
ampulla vater cancer and pancreatic cancer [28.4% of patients (n=33); and
12.1% (n=14), respectively]. The specificity of papillary forceps biopsy in the
diagnosis of periampullary area tumors was found to be 96.7%, and sensitivity
was 72.4%. When the endoscopist view was evaluated according to the
papillary endoscopic appearance, sensitivity was measured as 64.3%. Only
CA-19-9 levels were statistically different between pancreatic head cancer
and ampulla vater cancer groups (365 U/ml and 78 U/mL, respectively; p =
0.01). Conclusion: Papillary forceps biopsy performed with duodonoscopy
is a useful method in the differential diagnosis of periampullary tumors. This
method can be further improved by the evaluation of endoscopic apparance
of papillae and additionally by using tumor markers.

Anahtar Kelimeler

periampullary tumors, Papillary forceps biopsy

Kaynakça

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