• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Endoscopic ultrasound (EUS) enhances pre-resection stage determination compared to CT or PET for ampullary cancer

Endoscopic ultrasound (EUS) enhances pre-resection stage determination compared to CT or PET for ampullary cancer

Joyce Wong, MD, Zachary J Thompson, PhD, Cynthia Harris, MD, Jason Klapman, MD, Shivakumar Vignesh, MD, Barbara Centeno, MD, Pamela J Hodul, MD. Moffitt Cancer Center.

Introduction: Ampullary cancers are relatively uncommon neoplasms; conventional imaging has limited sensitivity in determining pre-resection stage. This study set out to evaluate the utility of endoscopic ultrasound (EUS) as an adjunct to computed tomography (CT) and positron electron tomography (PET) in the setting of ampullary neoplasms.

Methods: A database of patients undergoing resection for ampullary cancer from 1996-2013 was retrospectively reviewed. Patients undergoing pre-operative imaging with CT, PET and EUS were included in this study. Frequency of detection and agreement between imaging modalities were performed with Kappa statistics and exact binomial confidence intervals, where applicable. Goodman-Kruskal gamma statistics were used to quantify the correlation between imaging and pathologic stage.

Results: 91 patients underwent resection for ampullary cancer; in this cohort, 68 (75%) had adenocarcinoma, an additional 17 (19%) had adenocarcinoma, intestinal type. Six (6%) had uncommon pathology: papillary carcinoma and mucinous carcinoma. 79 (87%) had a pre-operative CT scan; 25 (33%) had a mass identified in the ampullary region on CT. 43 (47%) had a PET scan, of which 33 (77%) demonstrated avidity in the ampullary region. 56 (62%) underwent EUS; 49 (88%) of which demonstrated a mass. When correlating patients who underwent both CT and EUS, the Kappa correlation (95% CI) for presence of mass was 0.12 (-0.01-0.24), with EUS demonstrating a mass more frequently than CT, p<0.001. When comparing PET detection of an ampullary mass compared to EUS, Kappa correlation was -0.1 (-0.37-0.17).

90 (99%) patients underwent pancreaticoduodenectomy; one (1%) patient underwent ampullectomy. Final pathology demonstrated 26 (29%) with stage 3 disease, 36 (40%) with stage 2 disease, 28 (31%) with stage 1 disease, and 1 (1%) with no residual tumor identified. Pre-operative EUS stage was categorized into stage 1 or stage 2/3 and compared with final pathology. Gamma correlation was only 0.3 (-0.31-0.91) between EUS tumor (T) stage and final T stage; 16 (73%) with T stage 3 or 4 were identified by EUS, versus 7 (41%) of T stage 1 or 2 corresponding to EUS T stage 1 or 2. Gamma correlation was 0.74 (0.34-1.00) between EUS stage and final pathologic stage. Correlation was improved in stage 2 and 3 disease, with 25 (83%) with EUS stage 2/3 correlating to pathologic stage 2/3 disease; only 4 (50%) with stage 1 disease had a corresponding stage 1 by EUS. Presence of mass on CT, dilated biliary duct on CT, or PET avidity of the ampullary region were not correlated with final pathologic stage.

Conclusions: Ampullary cancers present a diagnostic challenge to clinicians, often with conventional imaging providing limited staging information. This study supports the use of EUS as an adjunct that may provide improved localized staging information, particularly for more advanced cancers.
 

View Poster

175

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals