ENDOSCOPIC ULTRASONOGRAPHY ASSESSMENT IN PREOPERATIVE STAGING FOR CARCINOMA OF AMPULLA OF VATER AND EXTRAHEPATIC BILE-DUCT

Objective. To evaluate preoperatively the extent of primary tumor, inv olvement of regional lymph node, and distant metastasis of ampullary c arcinoma and extra hepatic bile duct carcinoma. Methods. 28 patients w ith ampullary carcinoma and the 18 patients with extrahepatic bile duc t carcinoma were subjected to endoscopic ultrasonography (EUS). The re sults were compared with those of surgical explorations and pathologic al findings of the resected specimens for evaluating the accuracy of p reoperative staging of EUS. 46 patients underwent surgical exploration s. Radical resection with detailed pathological study was done for 22 patients with resectable ampullary carcinoma and 18 patients with extr ahepatic bile duct carcinoma. Carcinomas of ampulla of Vater and extra hepatic bile duct were staged according to the tumor, nodes, metastasi s (TNM) classification. Results. The accurate rate of EUS in assessing the extent of cancer invasion was 81.8% for ampullary cat-cinema, and 72.2% for extrahepatic bile duct carcinoma. The accuracy of EUS in pr edicting regional lymph node metastasis was 59% for ampullary carcinom a, and 61.1% for extrahepatic bile duct carcinoma. Invasion of port al Vein was correctly predicted by EUS in 2 of 3 patients, but the 3 cas es of liver metastasis were not detected by EUS. Conclusions. EUS is a n effective method for the evaluation of the extent of invasion of amp ullary carcinoma and extrahepatic bile duct carcinoma as well as the i nvolvement of regional lymph node before operation. Because of its lim ited penetration depth, however, EUS is inadequate in the assessment o f liver metastasis.