Editorial
Copyright ©The Author(s) 2015.
World J Gastroenterol. Jul 14, 2015; 21(26): 7970-7987
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.7970
Table 1 Staging classification of the ampullary neoplasms according to the American Joint Committee on Cancer TNM classification, 7th edition[47]
T = Primary Tumor
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to ampulla of Vater or sphincter of Oddi
T2Tumor invades duodenal wall
T3Tumor invades pancreas
T4Tumor invades peripancreatic soft tissue or other adjacent organs or structures other than pancreas
N = Regional Lymph Nodes
NXRegional lymph nodes cannot be assessed
N0No regional lymph node metastasis
N1Regional lymph node metastasis
M = Distant Metastasis
MXDistant metastasis cannot be assessed
M0No distant metastasis
M1Distant metastasis
G = Histologic Grade
GXGrade cannot be assessed
G1Well differentiated
G2Moderate differentiated
G3Poorly differentiated
G4Undifferentiated
StageTNM
0TisN0M0
IAT1N0M0
IBT2N0M0
IIAT3N0M0
IIBT1N1M0
T2N1M0
T3N1M0
IIIT4Any NM0
IVAny TAny NM1
Table 2 Survival in papillary tumors and predictors of poor prognosis
Ref.n/resectedOperative mortality (%)Positive nodes (%)R0 (%)Pancreatobil/intestinal, n (%)Survival-resected
Median survival - resected (mo)Predictors of worse survival or recurrence
5 yr10 yr
Albagli et al[128]50/508.036.0--N0 52%--None
N+ 39%
Allema et al[136]67/671.552.075.0-50%-R+
Beger et al[50]171/1713.154.079.6-N+ 21%--N+2, Pan+, R, Stage2, G2-3
N0: 63%
Bettschart et al[18]88/700.040.097.237.9145.8Bilirubin2, Age > 70, G3, N+2, Neu+, Pan+
Brown et al[91]72/512.047.0100.0-58%N+2, T, G
Carter et al[137]157/145-33.086.053 (45)-54 (46)---Pancreatobil2, Bilirubin, Stage2, N+, T, Ly+2, Neu+2
Chareton et al[35]63/517.5---40%-Stage, Ampullectomy
Choi et al[129]78/702.631.495.7-59.90%29%70Jaundice, Ulcerated, Pan+, G
N0 63.5%
N+ 50.8%
Di Giorgio1 et al[138]94/648.628.0100.0-64.4%54No resection , Size, G, Depth of infiltration2
Duffy et al[92]550.041.898.2-67.70%--Neu+2
Falconi et al[19]90/904.048.061% (disease free)Stage, T, LNR2
Hornick et al[16]157/15059.8Adenocarcinoma 45%Jaundice, Stage, N+
106Adenoma 82%
AdenocarcinomaN+ 47%
N0 63%
Howe1 et al[28]123/1015.045.596.1-46%-58.8No resection, N+2, R+2, G3
Iacono et al[139]59/597.837.3--46%33%31G, T2, N+, Chromosome 17p2, 18q2, Micro satellite instab., Standard PD
Inoue et al[140]34/3452.6%N+2, Pan+, V+2, Neu+2, SMA2
Kawaguchi et al[141]28/2856.4%37Duo+, Ly+, V+2
Kim et al[34]104/10439.462 (60)-42 (40)60.1%57.6%T2, CEA, N+2, G32, Pancreatobil2, Neu+, Ly+
Kimura et al[36]51-45.0-38 (74)-13 (25)Pancreatobil
Klempnauer et al[142]94/949.638.097.0-34.5%28.6%-Size2, G3, N+, Stage
Lazaryan et al[20]72/72-34.096.0-61%--Neu+2, Ulcerated2, N+2, Stage, Weight loss
Norero et al[143]50/5032%28N+2
Ohike et al[134]244/244-38.095.0162 (66) other33%--Budding2, N+2, T2, R+2
82 (34) intestinalHi budding 24%
Low budding 68%
Qiao et al[59]127/1279.735.098.443.3%35.7%N+2, T2, Stage, Pan+
Roder et al[144]69/664.542.0--35%-41N(nr)
Sakata et al[130]71/710.048.097.264%55%G, Pan+, Ly+2, V+2, Neu+, R+, N+2, LNR
Shinkawa et al[145]23/2352%32%Pan+, N+
Talamini1 et al[51]120/1063.840.0--38%-46No resection, Transfusion2, N+, G2-3
N+ 31%
N0 43%
Todoroki et al[95]66/590.060.093.2-52.6%R+, CEA, Ulcerated, T2, N+, Stage2, Ly+2, V+
Westgaard et al[25]114/1143.557.065.067 (59)-47 (41.2)-Pancreatobil2, N+2, V+2
41 ampullarySize2
Winter et al[127]450/4502.054.596.1Adenocarcinoma 45%N+ 23.4N+2, Neu+2, Transfusion2
Adenoca: 347Adenoma 86%N0 79
N+ 35%
N0 56%
Yokoyama et al[15]74/59-53.5100.0-61.0%53%-Pan+2, N+2, Jaundice, V+, Ly+2, Neu+, G
Zhao et al[146]105/1058.637.142.8%Pan+, Size2, T, TNM stage, N(nr)2
1Including not resected pts;
2Independent predictor; duo+: Duodenal invasion; G: Histologic grade of differentiation; LNR : Lymph nodes ratio; Ly+: Lymphatic vessel invasion; N+: pOsitive lymph nodes; N(nr): Number of metastatic lymph nodes; Neu+: Perineural invasion; Pan+: Pancreatic invasion; Pancreatobil: Pancreatobiliary histological subtype; R+: Positive resection margins; No resection: Patients not resected vs those who underwent surgical resection; SMA: Lymphadenectomy around the superior mesenteric artery; V+: Blood vessel invasion.
Table 3 Accuracy of various methods in indenfying and staging papillary tumors
Ref.nTestTumor detection
T
N
Resectability
SensSpecAccAccSensSpecAccSensSpecAcc
Artifon et al[147]27CT---51.8%40.0%65.0%55.5%---
EUS---74.1%70.0%88.0%81.4%---
Buscail et al[148]6EUS---83.0%--100.0%100.0%100%100%
Cannon et al[79]50CT---24.0%--59.0%---
MRI---46.0%--77.0%---
EUS---78.0%--68.0%---
Chen et al[61]19US5.0%--11.0%7.0%-----
CT21.0%--22.0%33.0%-----
EUS95.0%--72.0%47.0%-----
Chen et al[5]41US--12.2%-------
CT--28.6%26.1%0.0%-44.0%---
MRI--81.3%53.8%25.0%-77.0%---
EUS--97.6%72.7%47.0%-67.0%---
Heinzow et al[84]72IDUS87.5%92.5%90.2%---75.0%---
ETP68.7%100.0%86.0%-------
IDUS +ETP97.0%100.0%94.5%-------
Howard et al[149]21CT-------63.0%100%86%
EUS-------75.0%77%76%
Kubo et al[85]35EUS---74.0%--63.0%---
Manta et al[82]24MRI75.0%---------
EUS100.0%---------
Midwinter et al[63]34CT76.0%---33.0%86.0%----
EUS97.0%---44.0%93.0%----
Mukai et al[83]23EUS96.0%--78.0%------
Qiao et al[59]127US7.9%---------
CT19.0%---------
Rösch et al[64]28US7.0%---------
CT29.0%---------
EUS93.0%---------
Skordilis et al[60]20US15.0%---------
CT20.0%---------
EUS100.0%--82.0%--71.0%---
Tio et al[150]32EUS---84.4%68.8%37.5%53.1%---
Acc: Accuracy; CT: Computerized tomography; ETP: Endoscopic transpapillary forceps biopsies; EUS: Endoscopic ultrasonography; IDUS: Transpapillary intraductal ultrasonography; MRI: Magnetic resonance imaging; Sens: sensitivity; Spec: Specificity.