Endoscopic ultrasonography assessment for ampullary and bile duct malignancy

From 1989 through 1992, endoscopic ultrasonography (EUS) was undertaken preoperatively to evaluate the extent of primary tumor, involvement of regional lymph nodes, and distant metastases in 22 patients with ampullary carcinoma and 18 patients with bile duct carcinoma. The results were compared with histopathological findings according to the TNM staging system. The accurate rate in assessing the extent of cancer invasion was 82% for ampullary carcinoma, 66% for common hepatic duct carcinoma, and 78% for common bile duct carcinoma. The accuracy of EUS in predicting regional lymph node metastasis was 59% for ampullary carcinoma, 56% for common hepatic duct carcinoma, and 67% for common bile duct carcinoma. Invasion of the portal vein was correctly predicted by EUS in 2 of 3 patients. None of the 3 patients with liver metastasis was detected by EUS. Therefore, endoscopic ultrasonography is an effective method in the evaluation of the extent of cancer invasion of ampullary and bile duct carcinoma as well as the involvement of regional lymph nodes preoperatively. However, due to its limited penetration depth, EUS is inadequate in the assessment of liver metastasis.