DIAGNOSTIC ACCURACY OF PREOPERATIVE PARAMETERS IN AMPULLARY AND PERIAMPULLARY LESIONS praneetha.modumudi@gmail.com

 

DIAGNOSTIC ACCURACY OF PREOPERATIVE PARAMETERS IN AMPULLARY AND PERIAMPULLARY LESIONS

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India

Oral or Poster

Ampullary and periampullary lesions often present early due to biliary obstruction, but distinguishing malignancy preoperatively remains a challenge. Histopathology remains the gold standard. This study evaluates the diagnostic accuracy of clinical, biochemical, radiological, and histological parameters in predicting malignancy.

This prospective observational study included 30 patients who underwent pancreaticoduodenectomy between December 2020 and August 2022 at Kasturba Hospital, Manipal. Clinical, biochemical, radiological, and histological parameters were recorded preoperatively and compared with final histopathological examination (HPE) results.

Of 30 patients, 19 were male and 11 female (mean age: 58 years). HPE confirmed 28 malignant and 2 benign lesions. • Clinical parameters: Weight loss, pancreatitis, and new-onset diabetes had sensitivities of 71%, 17%, and 17%; and specificities of 0%, 50%, and 100%, respectively. • Biochemical markers: Total bilirubin and direct bilirubin showed sensitivities of 60% and 85%; specificities of 50% and 0%. CA 19-9 and CEA had sensitivities of 71.4% and 7.1%, and specificities of 0% and 100%. • Radiology (CECT abdomen): Sensitivity 78%, specificity 50%. • Histological (EUS-guided FNAC): Sensitivity 83%, specificity 100%, accuracy 84.6%.

Preoperative biopsy (EUS-FNAC) demonstrated the highest diagnostic accuracy for predicting malignancy in ampullary and periampullary lesions, followed by radiology (CECT), biochemical markers (direct bilirubin, CA 19-9), and clinical parameters (new-onset diabetes, weight loss).