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: 2.25). 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.

2 Followers
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    • "In Table 2 are summarized the results of all studies in which a standard 19-gauge needle has been used to gather samples for histologic analysis, independently of the sampling technique utilized.[303132333435363738394041] Excluding the study from Itoi et al.[30] in which a high technical failure rate was found when the procedure was performed through the duodenum, the overall technical success and yield in all the published studies were above 90%. "
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    ABSTRACT: Endoscopic ultrasound (EUS)-guided fine needle aspiration has emerged as the procedure of choice to obtain samples to reach a definitive diagnosis of lesions of the gastrointestinal tract and of adjacent organs. The obtainment of a tissue core biopsy presents several advantages that can substantially contribute to the widespread diffusion of EUS utilization in the community and in countries where cytology expertise may be difficult to be achieved. This article will review the EUS-guided fine needle biopsy techniques developed so far, the clinical results, their limitations as well as their future perspective.
    Full-text · Article · Mar 2014
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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. "

    Full-text · Dataset · Apr 2013
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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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    ABSTRACT: Previously, we showed that the expression of potassium channel tetramerization domain-containing 12 (KCTD12), which was discovered by a proteomics approach, is associated with high-risk behavior of gastrointestinal stromal tumors (GISTs). Here, we examined the distribution and expression of this protein by immunostaining with a commercially available polyclonal KCTD12 antibody in GISTs (n = 64) and other types of malignancy (n = 168) to clarify its diagnostic and clinical significance. Diffuse KCTD12 immunoreactivity was found in most GISTs (52 cases; 81%). KCTD12 expression was observed primarily in vascular endothelial cells, Purkinje cells of the cerebellum, and some neurons scattered throughout the cerebral cortex. KCTD12 was absent from not only the interstitial cells of Cajal but also interstitial cells of Cajal hyperplasia that was encountered incidentally in colon diverticulitis. KCTD12 immunostaining was also seen in malignant peripheral nerve sheath tumors (2/10 cases; 20%), synovial sarcomas (2/10; 20%), solitary fibrous tumor (1/8; 13%), angiosarcoma (1/7; 14%), and colon adenocarcinoma (1/24; 4%). In survival analyses, the 5-year recurrence-free survival rate of patients without KCTD12 expression was only 16.7% compared with 95.6% in those with KCTD12 expression (P < .0001). Ki-67 and KCTD12 were significant predictors of recurrence-free survival, and KCTD12 expression provided additional information about recurrence-free survival after accounting for Ki-67 status. Overall, KCTD12 expression was specific for GISTs from neoplastic and nonneoplastic adult tissues other than brain and served as a predictor of GIST recurrence. These findings suggest that KCTD12 is a useful and reliable biomarker for both the diagnosis and prognosis of GIST.
    Full-text · Article · Jan 2013 · Human pathology
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