Article

Endosonographic large-bore biopsy of gastric subepithelial tumors: A prospective multicenter study

aDepartment of Gastroenterology and Hepatology, German Clinic for Diagnostics, Wiesbaden bDepartment of Internal Medicine and Gastroenterology, Klinikum Märkisch Oderland, Wriezen cDepartment of Gastroenterology and Hepatology, Central Interdisciplinary Endoscopy, Charité Campus Virchow dDepartment of Internal Medicine and Gastroenterology, Maria Heimsuchung Caritas-Klinik eDepartment of Pathology, Charité Campus Mitte, Berlin fDepartment of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany.
European journal of gastroenterology & hepatology (Impact Factor: 2.15). 07/2012; 24(10):1135-1144. DOI: 10.1097/MEG.0b013e328356eae2
Source: PubMed

ABSTRACT BACKGROUND: Once gastric subepithelial lesions (SEL) are found, tissue diagnosis is required, considering the possible differential diagnosis of gastrointestinal stromal tumors (GIST). Previous studies have shown insufficient accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using cytologic analysis. METHODS: The feasibility and yield of EUS-FNA-based histologic tissue acquisition for gastric SEL, using 19 G large-bore needles, was assessed in a 4-year multicenter, prospective study. All consecutive patients, who were referred for EUS-FNA for all SEL greater than 1 cm, were included. RESULTS: Of 100 patients with suspected gastric SEL, 71 lesions were found to be eligible. Endoscopic biopsies or resections or surgery were used alternatively for a variety of reasons in 25 patients. EUS-FNA using the 19 G needle was finally performed in 46/71 cases (65%) with one to four needle passes. Sufficient material for a definite or a suspected histological diagnosis was obtained in 52 and 7% of the cases, respectively. In 41%, the samples were not informative. Immunohistochemistry was possible in 91% of cases with sufficient amounts of tissue; 30% were GIST. Self-limited, mild hemorrhage occurred in 22%; one patient developed a fatal abscess. CONCLUSION: Even when intended, EUS-guided 19 G FNA is only feasible in 46% of gastric SEL. The diagnostic yield of 19 G FNA was only 52%, but with excellent differentiation between GIST and leiomyoma. Infectious complications must be prevented.

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    • "The current univariate logrank test indicates that, taken alone, Ki-67 and KCTD12 are significant predictors of RFS, and KCTD12 expression provides additional information about RFS after accounting for Ki-67 status. As described previously, typically, the all-or-none KCTD12 staining pattern within tumor cells allows for the easy identification of high-risk patients with GISTs, even for small biopsy specimens taken with endoscopic ultrasoundguided fine-needle aspiration [25] [26]. In fact, we observed a perfect concordance of a " positive " or " negative " assessment of KCTD12 staining between preoperative endoscopic ultrasound-guided fine-needle aspiration biopsy and resected specimens in several GIST cases examined so far. "
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    • "The current univariate logrank test indicates that, taken alone, Ki-67 and KCTD12 are significant predictors of RFS, and KCTD12 expression provides additional information about RFS after accounting for Ki-67 status. As described previously, typically, the all-or-none KCTD12 staining pattern within tumor cells allows for the easy identification of high-risk patients with GISTs, even for small biopsy specimens taken with endoscopic ultrasoundguided fine-needle aspiration [25] [26]. In fact, we observed a perfect concordance of a " positive " or " negative " assessment of KCTD12 staining between preoperative endoscopic ultrasound-guided fine-needle aspiration biopsy and resected specimens in several GIST cases examined so far. "
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