Diagnostic efficacy of linear array ultrasound gastroscopy versus enhanced CT examination and magnetic resonance imaging for duodenal papillary carcinoma

Objective To compare the diagnostic efficacy of linear endoscopic ultrasonography (EUS), enhanced CT examination and magnetic resonance imaging(MRI)for major duodenal papilla carcinoma.

Methods Seventy-nine patients with duodenal papilla occupying lesion were selected as study objects, separately undergoing EUS, enhanced CT-scan and MRI of the upper abdomen, the results of EUS, CT and MRI were compared with those of gold standard results (endoscopic retrograde cholangiopancreatography, biopsy histology or surgical pathology, etc.). The diagnostic efficiency (sensitivity, specificity and accuracy) of EUS, enhanced CT and MRI for major duodenal papilla carcinoma were calculated to make statistical comparison.

Results Of 79 cases with duodenal papilla occupying lesions, 71 patients were diagnosed as duodenal papilla carcinoma by gold standard, 8 were diagnosed as duodenum adenoma or low grade intraepithelial neoplasia. EUS diagnosis results showed there were 73 cases of duodenal papillary carcinoma (2 cases of duodenal papillary adenoma or low-grade intraepithelial neoplasia by gold standard) and 6 cases of duodenal papillary adenoma or low-grade intraepithelial neoplasia. A total of 30 cases of duodenal papillary carcinoma and 49 cases of duodenal adenoma or low-grade intraepithelial neoplasia were diagnosed by enhanced CT examination. MRI results showed that there were 38 cases of duodenal papillary carcinoma (their gold standard results were all duodenal papillary carcinoma), 41 cases of duodenal papillary adenoma or low-grade intraepithelial neoplasia. The diagnostic sensitivity of EUS for duodenal papillary carcinoma was 100.00% (71/71), which was higher than 42.25%(30/71) of enhanced CT and 53.52%(38/71) for MRI (P < 0.01). The diagnostic accuracy of EUS for duodenal papillary carcinoma was 97.47%(77/79), which was higher than 48.10%(38/79)of enhanced CT and 58.23% (46/79) of MRI (P < 0.01). There was no significant difference in diagnostic specificity of US examination compared with CT examination and MRI examination (P>0.05).

Conclusion Compared with enhanced CT and MRI, EUS has higher diagnostic efficacy in duodenal papillary carcinoma, and shows higher sensitivity and accuracy. EUS can obtain pathological biopsy specimens at the same time, so it is a preferred mean of examination for patients with duodenal papillary space occupying lesions.