Tumors of the papilla of Vater - inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy

Background: It has been proposed that adenomas of the papilla of Vater are precursors of adenocarcinomas. Duodenoscopy with ERCP and forceps biopsies have substantially improved the morphologic exploration of the major duoden al papilla. Yet there is little and contradictory information as to the dia gnostic accuracy of endoscopic biopsies in tumors of the papilla. Moreover, after endoscopic sphincterotomy data on the diagnostic impact of endoscopi c biopsies from the papilla are scarce and, in most cases, retrospectively obtained. Thus, the aim of the present prospective and histopathologically controlled study was to assess the diagnostic accuracy of endoscopic biopsi es taken from tumors of the papilla before and after sphincterotomy. Patients and methods: Forty patients with tumors of the papilla of Vater we re included in the study. In each case, a comparison was made between endos copic forceps biopsy diagnoses prior to and following sphincterotomy and th e definitive histological diagnosis after surgical tumor resection. Results: Resected tumors were diagnosed histomorphologically as follows: 19 adenocarcinomas (47%), 6 tubular adenomas (15%), 7 villous adenomas (17%), 7 inflammatory non-neoplastic lesions (pseudotumors) (17%), and one adenom yoma (2%). Overall accuracy for preoperative histopathological diagnosis wa s 62% (25 of 40, 95% CI: 47%-76%) prior to sphincterotomy while it was 70% (28 of 40, 95% CI: 55%-81%) following the procedure. Regarding adenocarcino mas, sensitivity was found to be 21% (4 of 19, 95% CI: 8%-43%) prior to and 37% (7 of 19, 95% CI: 19%-58%) after sphincterotomy while specificity was 100% at both times. Conclusions: Endoscopic forceps biopsies do not allow for reliable preopera tive diagnosis of tumors of the papilla of Vater.