Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5560-5567
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5560
Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas
Naomi Kakushima, Hideyuki Kanemoto, Keiko Sasaki, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono
Naomi Kakushima, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Kenichiro Imai, Kinichi Hotta, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 4118777, Japan
Hideyuki Kanemoto, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka 4118777, Japan
Keiko Sasaki, Division of Pathology, Shizuoka Cancer Center, Shizuoka 4118777, Japan
Author contributions: Kakushima N, Kanemoto H and Sasaki K contributed equally to this work; Kakushima N, Kawata N, Tanaka M and Takizawa K designed and performed the research; Imai K, Hotta K, Matsubayashi H and Ono H contributed to the analytic tools and analysis of the data; Kakushima N, Kanemoto H, Sasaki K and Matsubayashi H wrote the paper.
Ethics approval: This study was reviewed and approved by the Shizuoka Cancer Center institutional review board.
Informed consent: All patients gave written informed consent prior to their endoscopic examination. Informed consent for study inclusion was omitted due to the retrospective use of data extracted from past charts and reports.
Conflict-of-interest: The authors report no conflict-of-interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naomi Kakushima MD, PhD, Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka 4118777, Japan. kakushin-tky@umin.ac.jp
Telephone: +81-55-9895222 Fax: +81-55-9895692
Received: November 5, 2014
Peer-review started: November 6, 2014
First decision: November 26, 2014
Revised: December 10, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: May 14, 2015
Abstract

AIM: To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).

METHODS: Clinicopathological data were reviewed for 84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September 2002 and August 2014 at a single prefectural cancer center. Superficial NADETs were defined as lesions confined to the mucosa or submucosa. Demographic and clinicopathological data were retrieved from charts, endoscopic and pathologic reports. Endoscopic reports included endoscopic diagnosis, location, gross type, diameter, color, and presence or absence of biopsy. Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained. Endoscopic images were obtained using routine, front-view, high-resolution video endoscopy, and chromoendoscopy with indigocarmine was performed for all lesions. Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma. Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens. Sensitivity, specificity, and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.

RESULTS: The majority (81%) of the lesions were located in the second portion of the duodenum. The median lesion diameter was 14.5 mm according to final histology. Surgery was performed for 49 lesions from 39 patients, and 35 lesions from 35 patients were endoscopically resected. Final histology confirmed 65 carcinomas, 15 adenomas, and 3 hyperplasias. A final diagnosis of duodenal carcinoma was made for 91% (52/57) of the lesions diagnosed as carcinoma by endoscopy and 93% (42/45) of the lesions diagnosed as carcinoma by biopsy. The sensitivity, specificity, and accuracy of endoscopic diagnoses were 80%, 72%, and 78%, respectively, whereas those of biopsy diagnoses were 72%, 80%, and 74%, respectively. Preoperative diagnoses of carcinomas were made in 88% (57/65) of the carcinoma lesions via endoscopy or biopsy. Endoscopic findings associated with carcinoma were red color, depression, and mixed-type morphology.

CONCLUSION: Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.

Keywords: Biopsy, Endoscopic diagnosis, Duodenal adenoma, Duodenal carcinoma, Duodenal neoplasms

Core tip: An analysis of 84 resected lesions of superficial nonampullary duodenal epithelial tumors revealed that preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma or adenoma. Endoscopic findings associated with superficial duodenal carcinoma were red color, depression, and mixed-type morphology.