Does Previous Biopsy Lead To Cancer Overdiagnosis Of Superficial Non-Ampullary Duodenal Epithelial Tumors?

Background and study aims We aimed to evaluate the diagnostic performance of magnifying endoscopy with narrow-band imaging (M-NBI) in superficial non-ampullary duodenal epithelial tumors (SNADETs) regarding the absence or presence of biopsy before M-NBI diagnosis. Patients and methods Clinicopathological data were retrospectively reviewed for 99 SNADETs from 99 patients who underwent endoscopic resection. The 99 tumors were divided into the non-biopsy group (32 lesions not undergoing biopsy before M-NBI examination) and the biopsy group (67 lesions undergoing biopsy before M-NBI examination). We investigated the correlation between the M-NBI diagnosis and the histopathological diagnosis of the SNADETs in both groups.Results According to the modified revised Vienna classification, 31 tumors were classified as category 3 (C3) (low-grade adenoma) and 68 as category 4/5 (C4/ 5) (high-grade adenoma/cancer). The accuracy, sensitivity, and specificity of preoperative M-NBI diagnoses in the non-biopsy group vs the biopsy group were 88% (95% confidence interval: 71.0 - 96.5) vs 66% (51.5 - 75.5), P = 0.02; 95% (77.2 - 99.9) vs 89% (76.4 - 96.4), P = 0.39; and 70% (34.8 - 93.3) vs 14% (3.0 - 36.3), P < 0.01, respectively. Notably, in the biopsy group, the specificity of M-NBI in SNADETs was low at only 14% because we over-diagnosed most C3 lesions as C4/ 5. M-NBI findings might have been compromised by the previous biopsy procedure itself.Conclusions In the non-biopsy group, the accuracy of M-NBI in SNADETs was excellent in distinguishing C4/5 lesions from C3. The M-NBI findings in SNADETs should be evaluated while carefully considering the influence of a previous biopsy.