Diagnostic value of endoscopic ultrasonography for duodenal papillary carcinoma and analysis on influencing factors

To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in the preoperative staging and ductal dilatation of duodenal papillary carcinoma and analyze the factors influencing its diagnostic accuracy.

A cross-sectional trial was conducted on the patients with pathologically-diagnosed duodenal papillary carcinoma and undergoing EUS in the First Affiliated Hospital of Army Medical University from January 2018 to August 2023. The diagnostic value of EUS for the preoperative staging of duodenal papillary carcinoma was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Univariate and multivariate analyses were performed to determine the factors affecting the diagnostic accuracy of EUS.

A total of 102 patients with duodenal papillary carcinoma were included, including 59 males and 43 females, at a mean age of 62 years, and all of them underwent EUS before diagnosis. The accuracy of EUS for tumor T-staging was 86.27%, the sensitivity and specificity for T1, T2, T3, and T4 lesions were 84.21%, 92.31%, 85.00%, 60.00%, and 95.31%, 88.89%, 96.34%, and 98.97%, respectively. The positive predictive value for T-staging of T1, T2, T3, and T4 lesions was 91.43%, 83.72%, 85.00%, and 75.00%, and the negative predictive values were 91.04%, 94.92%, 96.34%, and 97.96%, respectively. There were 14 patients whose T-staging was incorrectly staged by EUS. The accuracy of EUS in assessing intraductal dilatation was 75.49%, and the sensitivity, specificity, positive predictive value, and negative predictive value for ductal dilatation were 96.97%, 66.67%, 98.97%, and 40.00%, respectively. In addition, the independent predictors of diagnostic accuracy of EUS for pancreatic duct dilatation were nerve infiltration, tumor size, and T stage; whereas the independent risk factors for diagnostic accuracy of bile duct dilatation were nerve infiltration and alkaline phosphatase.

EUS has quite higher diagnostic value for preoperative staging of duodenal papillary carcinoma, and nerve infiltration, tumor size, T stage, T stage and alkaline phosphatase may be the influencing factors for its diagnostic accuracy.