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Tumor diameter and Ki-67 expression in biopsy could be diagnostic markers discriminating from adenoma and early stage cancer in patients with ampullary tumors

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Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background

Ampullary early stage cancer (early CA) potentially harbors lymphovascular invasion; there are few data on markers that could differentiate adenoma and early CA.

Aim

To investigate those markers, we compared the tumor diameter and Ki-67 expression in endoscopy biopsy specimens of adenoma with those of early CA.

Methods

Patients on whom endoscopic papillectomy (EP) was performed (n = 35) with histopathologically proven adenomas and with low/high grade dysplasia and early CA were studied. We made pre-procedure evaluations of ampullary tumors by using endoscopic ultrasonography (EUS) and transpapillary intraductal ultrasonography. Tumor diameter was measured by EUS. Endoscopic biopsy using immunostaining of Ki-67 labeling index (LI) prior to EP were evaluated.

Results

The areas under the receiver-operating characteristic (AUROC) curves for tumor diameter and Ki-67 expression were 0.824 and 0.873, respectively. Cut-off values calculated based on AUROC data were 15 mm in tumor diameter and 32 cells/high-power field (HPF) in Ki-67. Early CA (n = 11) was diagnosed by using a cut-off value for tumor diameter in 8 out of 11 patients (sensitivity 72.7 %, specificity 66.7 %, accuracy 68.6 %). Significant infiltration of the major duodenal papilla by Ki-67 positive tumor cells (>31/HPF) was recognized in 8 of the 11 patients with early CA (sensitivity 100 %, specificity 54.2 %, accuracy 62.9 %).

Conclusions

Observation of tumor diameter and Ki-67 LI would be helpful for safety EP. EP should not be indicated for ampullary tumors more than 15 mm in diameter and/or Ki-67 LI 31/HPF.

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Authors and Affiliations

  1. Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, 236-0004, Japan

    Kensuke Kubota, Yuji Fujita, Takamitsu Sato, Seitaro Watanabe, Kunihiro Hosono, Masato Yoneda, Hiroyuki Kirikoshi & Atsushi Nakajima

  2. Department of Gastroenterology, Kanto Medical Center, Shinagawa, Tokyo, Japan

    Kantaro Hisatomi & Nobuyuki Matsuhashi

  3. Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan

    Itaru Endo

  4. Department of Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan

    Yoshiaki Inayama

Authors
  1. Kensuke Kubota
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  2. Yuji Fujita
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  3. Takamitsu Sato
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  4. Seitaro Watanabe
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  5. Kunihiro Hosono
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  6. Masato Yoneda
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  7. Hiroyuki Kirikoshi
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  8. Kantaro Hisatomi
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  9. Nobuyuki Matsuhashi
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  10. Itaru Endo
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  11. Yoshiaki Inayama
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  12. Atsushi Nakajima
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Correspondence to Kensuke Kubota.

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Kubota, K., Fujita, Y., Sato, T. et al. Tumor diameter and Ki-67 expression in biopsy could be diagnostic markers discriminating from adenoma and early stage cancer in patients with ampullary tumors. J Hepatobiliary Pancreat Sci 20, 531–537 (2013). https://doi.org/10.1007/s00534-013-0594-2

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