EUS-guided 22-gauge fine needle biopsy for the diagnosis of gastric subepithelial tumors larger than 2 cm

Abstract

Objective. EUS-guided fine needle biopsy (EUS-FNB) was introduced to obtain tissue cores. However, data on the efficacy of EUS-FNB for the diagnosis of gastric subepithelial tumors (SET) are limited. This study was aimed to determine the tissue acquisition and diagnostic yield of EUS-FNB using a novel 22-gauge FNB needle. Material and methods. Between May 2012 and February 2014, we retrieved data on 78 consecutive patients who underwent 22-gauge EUS-FNB for tissue sampling of gastric SET larger than 2 cm. Relevant tumor and EUS-related parameters were reviewed retrospectively. Results. The median tumor diameter was 2.8 cm and tumors were punctured successfully in 77 SET (98.7%). EUS-FNB was diagnostic in 81.8% of SET (63/77), by obtaining core biopsy tissue in 96.8% (61/63) and aspirates in 27.0% (17/63). FNB specimens permitted immunostaining for the diagnosis of gastrointestinal stromal tumors (GIST) in 30 SET (47.6%), 20 leiomyomas (31.7%), and 3 schwannomas (4.8%). Diagnoses could be made without immunostaining in 10 SET (15.9%). Tissue adequacy was optimal in 85.7% of FNB specimens by endosonographers’ on-site visual evaluation. Endosonographers’ evaluation of tissue adequacy was the only factor significantly associated with a higher diagnostic yield in univariate analysis. No adequate high-power fields for GIST risk stratification were available in FNB specimens. There was a single case of post-procedural bleeding (1.3%). Conclusion. EUS-FNB using 22-gauge needle obtains a high yield for the diagnosis of gastric SET ≥2 cm, mostly via core tissue acquisition. Endosonographers should pay careful attention to the adequacy of FNB specimens.

Key Words:

• endosonography
• fine-needle biopsy
• stomach
• subepithelial tumors

Acknowledgement

Study conception and design: Ho June Song. Acquisition of data: Jeong Hoon Lee, Charles J. Cho, Hee Kyong Na. Analysis and interpretation of data: Jeong Hoon Lee, Charles J. Cho, Young Soo Park. Drafting of manuscript: Jeong Hoon Lee, Charles J. Cho. EUS procedure: Jeong Hoon Lee, Ji Yong Ahn, Do Hoon Kim, Ho June Song. Critical revision: Ho June Song, Kee Don Choi, Gin Hyug Lee, Hwoon-Yong Jung.

Declaration of interest: All authors disclose no financial relationships relevant to this publication.