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Tumor diameter and Ki‐67 expression in biopsy could be diagnostic markers discriminating from adenoma and early stage cancer in patients with ampullary tumors
Author(s) -
Kubota Kensuke,
Fujita Yuji,
Sato Takamitsu,
Watanabe Seitaro,
Hosono Kunihiro,
Yoneda Masato,
Kirikoshi Hiroyuki,
Hisatomi Kantaro,
Matsuhashi Nobuyuki,
Endo Itaru,
Inayama Yoshiaki,
Nakajima Atsushi
Publication year - 2013
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-013-0594-2
Subject(s) - stage (stratigraphy) , adenoma , biopsy , cancer , pathology , medicine , tumor stage , oncology , biology , paleontology
Background Ampullary early stage cancer (early CA) potentially harbors lymphovascular invasion; there are few data on markers that could differentiate adenoma and early CA. Aim To investigate those markers, we compared the tumor diameter and Ki‐67 expression in endoscopy biopsy specimens of adenoma with those of early CA. Methods Patients on whom endoscopic papillectomy (EP) was performed ( n = 35) with histopathologically proven adenomas and with low/high grade dysplasia and early CA were studied. We made pre‐procedure evaluations of ampullary tumors by using endoscopic ultrasonography (EUS) and transpapillary intraductal ultrasonography. Tumor diameter was measured by EUS. Endoscopic biopsy using immunostaining of Ki‐67 labeling index (LI) prior to EP were evaluated. Results The areas under the receiver‐operating characteristic (AUROC) curves for tumor diameter and Ki‐67 expression were 0.824 and 0.873, respectively. Cut‐off values calculated based on AUROC data were 15 mm in tumor diameter and 32 cells/high‐power field (HPF) in Ki‐67. Early CA ( n = 11) was diagnosed by using a cut‐off value for tumor diameter in 8 out of 11 patients (sensitivity 72.7 %, specificity 66.7 %, accuracy 68.6 %). Significant infiltration of the major duodenal papilla by Ki‐67 positive tumor cells (>31/HPF) was recognized in 8 of the 11 patients with early CA (sensitivity 100 %, specificity 54.2 %, accuracy 62.9 %). Conclusions Observation of tumor diameter and Ki‐67 LI would be helpful for safety EP. EP should not be indicated for ampullary tumors more than 15 mm in diameter and/or Ki‐67 LI 31/HPF.