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Koizumi E, Goto O, Matsuda A, Otsuka T, Ishikawa Y, Nakagome S, Niikawa M, Habu T, Yoshikata K, Kirita K, Noda H, Higuchi K, Onda T, Omori J, Akimoto N, Yoshida H, Iwakiri K. Diagnostic ability and adverse events of mucosal incision-assisted biopsy for gastric subepithelial tumors: Systematic review and meta-analysis. Dig Endosc 2025; 37:236-246. [PMID: 39370533 DOI: 10.1111/den.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/02/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to evaluate the diagnostic ability and examine the efficacy of countermeasures to adverse events of mucosal incision-assisted biopsy (MIAB) for gastric subepithelial tumors (SETs). METHODS We performed a literature search and identified 533 relevant articles. Eleven articles, including 339 lesions, were ultimately used in the meta-analysis. The primary end-point was the pathological diagnostic rate of MIAB for gastric SETs, and the secondary end-point was the incidence of adverse events. The efficacy of acid secretion inhibitors in preventing postoperative bleeding and that of local injection before incision to prevent perforation were also examined. RESULTS Nine studies were conducted in Japan and two in South Korea, of which only two were prospective studies. The pooled pathological diagnostic rate of MIAB for gastric SETs was 87.8% (95% confidence interval [CI] 80.2-94.0; I2 = 68.7%). The adverse event rate of the pooled population was 0.2% (95% CI 0-1.4; I2 = 0%). The acid secretion inhibitors significantly reduced postoperative bleeding (odds ratio 0.06, 95% CI 0.01-0.66, P = 0.02). Perforation occurred in 0% and 2.6% of the local and nonlocal injection cohorts, respectively, and the pathological diagnostic rates were 50% and 66.7%, respectively. CONCLUSIONS MIAB is a reliable technique with a favorable diagnostic rate and few adverse events. Acid secretion inhibitors may effectively prevent postoperative bleeding; however, the efficacy of local injection remains unclear. This technique could be an option for tissue sampling in gastric SETs.
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Affiliation(s)
- Eriko Koizumi
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Endoscopy Center, Nippon Medical School Hospital, Tokyo, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yumiko Ishikawa
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Shun Nakagome
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Niikawa
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Tsugumi Habu
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Keiichiro Yoshikata
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Kumiko Kirita
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hiroto Noda
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Kazutoshi Higuchi
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Onda
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Naohiko Akimoto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
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Dong X, Gao L, Liu K, Bai J, Dong J, Fang N, Han Y, Liu Z. The progression rate and risk factor analysis of small gastric subepithelial tumors: a systematic review and meta-analysis. Surg Endosc 2025; 39:730-740. [PMID: 39753931 DOI: 10.1007/s00464-024-11496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 12/20/2024] [Indexed: 02/06/2025]
Abstract
BACKGROUND AND AIMS Small gastric subepithelial tumors (SETs) in the stomach can be managed through surveillance or resection. However, it is still controversial how often the lesion would progress if left untreated. This study aimed to evaluate the progression rate of small SETs and identify risk factors influencing tumor growth. METHODS PubMed, Cochrane Library, Web of Science, and Scopus were searched for relevant studies until March 2023. Patient information, endoscopic features of SETs, and surveillance information were extracted from each included study. A random-effects model was applied along with subgroup and sensitivity analyses. RESULTS Based on 14 studies with 5405 SETs smaller than 3.5 cm, the annual incidence of size increase was 4.0 (95%CI 2.2-5.8) per 100 person-years, and the overall incidence was 12.8% (95%CI 8.3%-17.3%) across a surveillance duration of 51.3 ± 16.9 months. The predicted risk factors for tumor growth included ≥ 1 cm lesion size (1-2 cm vs. < 1 cm, OR 2.61, 95%CI 1.80-3.79; and > 2 cm vs. 1-2 cm, OR 1.25, 95%CI 0.87-1.81), origin in the muscularis propria (OR 2.09, 95%CI 1.41-3.10), mucosal change (OR 3.27, 95%CI 1.95-5.50), irregular margin (OR 3.16, 95%CI 1.15-8.69), and hypoechoic pattern (OR 3.06, 95%CI 1.34-7.00). CONCLUSIONS Most small gastric SETs, particularly those smaller than 1 cm, did not increase in size during surveillance. Special attention should be given to lesions larger than 1 cm, originating from the muscularis propria, or exhibiting mucosal change, irregular margin, and hypoechoic pattern.
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Affiliation(s)
- Xin Dong
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Li Gao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Kai Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jiawei Bai
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jiaqiang Dong
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Nian Fang
- Department of Gastroenterology, The First Hospital of Nanchang (The Third Affiliated Hospital of Nanchang University), Nanchang, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Tanabe M, Saito M, Uno K, Koike T, Sato C, Hatta W, Asano N, Fujishima F, Kamei T, Masamune A. A Case of Superficial Esophageal Neuroendocrine Carcinoma with Marked Morphological Changes in a Short Period. Intern Med 2024:4344-24. [PMID: 39496452 DOI: 10.2169/internalmedicine.4344-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2024] Open
Abstract
A de novo whitish subepithelial lesion (SEL) with irregular vascular hyperplasia was detected in the lower thoracic esophagus during endoscopic surveillance. Special types of esophageal cancer were suspected; however, endoscopic biopsy specimens were inadequate for a diagnosis. Ten days later, endoscopic ultrasound showed a 7-mm homogeneously hypoechoic round mass in the submucosa, and a biopsy confirmed a histological diagnosis of esophageal neuroendocrine carcinoma (eNEC). Based on the clinical diagnosis of cT2N0M0, subtotal esophagectomy followed by adjuvant chemotherapy was performed immediately after endoscopic reexamination revealing a 20-mm reddish SMT. We herein report the marked changes in endoscopic findings of eNEC within 1.5 months.
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Affiliation(s)
- Mizuki Tanabe
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | | | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
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Kobayashi R, Hirasawa K, Ozeki Y, Sawada A, Nishio M, Sato C, Miwa H, Kaneko T, Sugimori K, Maeda S. Clinical course of small gastric subepithelial lesion less than 20 mm diagnosed by endoscopic ultrasound-guided fine-needle aspiration. J Gastroenterol Hepatol 2024; 39:1285-1290. [PMID: 38450593 DOI: 10.1111/jgh.16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIM Gastrointestinal stromal tumors (GISTs) are treated as malignant gastric subepithelial lesions (SELs), and resection is recommended. However, small gastric SELs < 20 mm with no malignant features are monitored without histopathological examination, and the frequency of malignancy is unknown. This study aimed to clarify the clinicopathological findings and clinical course of gastric SELs < 20 mm measured by endoscopic ultrasound (EUS). METHODS This retrospective cohort study included consecutive patients with small gastric SELs < 20 mm diagnosed using EUS at a tertiary referral center between 2009 and 2021. The clinical course after diagnosis using EUS-guided fine-needle aspiration (EUS-FNA) was reviewed. RESULTS Among 333 patients with small gastric SELs, 104 patients with 105 lesions underwent EUS-FNA. The pathological diagnosis was confirmed in 87 patients. GISTs were the most common pathology (47%). Among the 87 patients, 43 underwent therapeutic interventions, including tumor resection and chemotherapy. In groups of tumor resection, the pathological tumor size on the resected specimen was significantly larger than the size measured by EUS (19.5 mm vs 15.0 mm, P < 0.001), and 37% of resected SELs were 20 mm or over. No recurrence was observed after tumor resection during a mean follow-up period of 40 months. CONCLUSIONS Approximately 40% of small gastric SELs were malignant tumors, such as GIST, with most of them requiring treatment. Additionally, considering that the EUS measurement is 5 mm smaller than the pathological tumor diameter, further examinations, such as systematic EUS-FNA, may be required for SEL, including those smaller than 20 mm.
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Affiliation(s)
- Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Haruo Miwa
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kaneko
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Hirota S, Tateishi U, Nakamoto Y, Yamamoto H, Sakurai S, Kikuchi H, Kanda T, Kurokawa Y, Cho H, Nishida T, Sawaki A, Ozaka M, Komatsu Y, Naito Y, Honma Y, Takahashi F, Hashimoto H, Udo M, Araki M, Nishidate S. English version of Japanese Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) issued by the Japan Society of Clinical Oncology. Int J Clin Oncol 2024; 29:647-680. [PMID: 38609732 PMCID: PMC11130037 DOI: 10.1007/s10147-024-02488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/12/2024] [Indexed: 04/14/2024]
Abstract
The Japan Society of Clinical Oncology Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) have been published in accordance with the Minds Manual for Guideline Development 2014 and 2017. A specialized team independent of the working group for the revision performed a systematic review. Since GIST is a rare type of tumor, clinical evidence is not sufficient to answer several clinical and background questions. Thus, in these guidelines, we considered that consensus among the experts who manage GIST, the balance between benefits and harms, patients' wishes, medical economic perspective, etc. are important considerations in addition to the evidence. Although guidelines for the treatment of GIST have also been published by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO), there are some differences between the treatments proposed in those guidelines and the treatments in the present guidelines because of the differences in health insurance systems among countries.
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Affiliation(s)
- Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Nishinomiya, Japan.
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidetaka Yamamoto
- Department of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Shinji Sakurai
- Department of Diagnostic Pathology, Japan Community Healthcare Organization Gunma Central Hospital, Maebashi, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuo Kanda
- Department of Gastroenterology, Southern TOHOKU General Hospital, Koriyama, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toshirou Nishida
- Department of Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Akira Sawaki
- Department of Medical Oncology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan
| | - Yoichi Naito
- Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshitaka Honma
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Morioka, Japan
| | | | - Midori Udo
- Nursing Department, Osaka Police Hospital, Osaka, Japan
| | - Minako Araki
- Association of Chubu GIST Patients and Their Families, Nagoya, Japan
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Verloop CA, Goos JAC, Bruno MJ, Quispel R, van Driel LMJW, Hol L. Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review. Gastrointest Endosc 2024; 99:895-911.e13. [PMID: 38360118 DOI: 10.1016/j.gie.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND AIMS Obtaining adequate tissue samples in subepithelial lesions (SELs) remains challenging. Several biopsy techniques are available, but a systematic review including all available techniques to obtain a histologic diagnosis of SEL is lacking. The aim of this study was to evaluate the diagnostic yield and adverse event rates of endoscopic biopsies, EUS-guided FNA (EUS-FNA), EUS-guided fine-needle biopsy (FNB) (EUS-FNB), and mucosal incision-assisted biopsy (MIAB) for SELs in the upper GI tract. METHODS A search strategy in multiple databases was performed. The primary outcome was diagnostic yield, defined as the percentage of procedures in which histology was obtained and resulted in a definitive histopathologic diagnosis. Secondary outcome measures included reported procedure-related adverse events, which were graded according to the AGREE (Adverse Events in Gastrointestinal Endoscopy) classification. RESULTS A total of 94 original articles were included. Studies were classified per endoscopic technique to obtain histopathology. This resulted in 8 included studies for endoscopic biopsy methods, 55 studies for EUS-FNA, 33 studies for EUS-FNB, and 26 studies for MIAB. Pooled rates for diagnostic yield were 40.6% (95% confidence interval [CI], 30.8-51.2) for endoscopic biopsy, 74.6% (95% CI, 69.9-78.7) for EUS-FNA, 84.2% (95% CI, 80.7-87.2) for EUS-FNB, and 88.2% (95% CI, 84.7-91.1) for MIAB. Reported procedure-related adverse events graded AGREE II or higher were 2.8% to 3.9% for endoscopic biopsies, 1.0% to 4.5% for EUS-FNA, .9% to 7.7% for EUS-FNB, and 1.9% to 7.9% for MIAB. CONCLUSIONS Based on the available evidence, MIAB and EUS-FNB seem to be most effective in terms of achieving a high diagnostic yield, with similar rates of adverse events.
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Affiliation(s)
- Cynthia A Verloop
- Department of Gastroenterology, Maasstad Hospital, Rotterdam, the Netherlands.
| | - Jacqueline A C Goos
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Erasmus University Medical Centre, Rotterdam the Netherlands
| | - Rutger Quispel
- Department of Gastroenterology, Reinier de Graaf hospital, Delft, the Netherlands
| | - Lydi M J W van Driel
- Department of Gastroenterology, Erasmus University Medical Centre, Rotterdam the Netherlands
| | - Lieke Hol
- Department of Gastroenterology, Maasstad Hospital, Rotterdam, the Netherlands
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Gupta V, Chopde A, Chaudhari V, Bal M, Shrikhande SV, Bhandare MS. Primary Pancreatic GIST - A-Single Centre Case Series and Systematic Review of Literature. J Gastrointest Cancer 2024; 55:572-583. [PMID: 38324136 DOI: 10.1007/s12029-024-01024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon, omentum, retroperitoneum, abdominal wall, liver and pancreas with pancreas comprising less than 5% of it. Due to limited data, it is unknown if the results of GIST can be generalised for EGISTs. We thereby present the largest single-centre case series of primary pancreatic GIST so far with review of existing literature. METHODS A total of 9 patients of primary pancreatic GIST were treated at our institute from September 2016 to February 2023. After literature search for all studies published before February 2023, 51 articles including 57 patients were identified. Their clinicopathological data and survival analysis were assessed. RESULTS The median age of patients treated at our centre was 53 years with a female predominance. The most common epicentre was pancreatic head with abdominal pain as the most common presenting symptom. All 57 patients documented in literature belonged to a similar age group with similar gender predilection. The factors impacting DFS were histologic type, mitotic index, NIH risk category and adjuvant therapy. The median DFS was 74 months with a 5-year DFS being 71.9%, while the 5-year OS was 90.4%. CONCLUSION Pancreatic GIST is a rare entity. Due to limited evidence and evolving literature, results cannot be generalised to a larger population. Larger case series with longer follow-up data are required to further understand the disease biology and long-term outcomes of pancreatic GIST.
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Affiliation(s)
- Vipul Gupta
- Gastrointestinal and Hepato-pancreato-biliary services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Amit Chopde
- Gastrointestinal and Hepato-pancreato-biliary services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Vikram Chaudhari
- Gastrointestinal and Hepato-pancreato-biliary services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Shailesh V Shrikhande
- Gastrointestinal and Hepato-pancreato-biliary services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Manish S Bhandare
- Gastrointestinal and Hepato-pancreato-biliary services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India.
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Akahoshi K, Tamura S, Akahoshi K, Shiratsuchi Y, Koga H, Oya M, Ohishi Y, Koga T. Efficacy and histologic frequencies of endoscopic ultrasonography-guided tissue acquisition using conventional fine-needle aspiration needles for gastric subepithelial hypoechoic mass. Australas J Ultrasound Med 2024; 27:89-96. [PMID: 38784701 PMCID: PMC11109998 DOI: 10.1002/ajum.12382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Introduction/Purpose For gastric subepithelial lesions (GSELs) showing a hypoechoic mass (HM) on endoscopic ultrasonography (EUS) imaging, the utility of EUS-guided tissue acquisition using conventional fine-needle aspiration needles (EUS-TA-CFNAN) and the frequency of histological types remain unclear. This study aimed to examine this issue. Methods This prospective observational study enrolled 291 consecutive patients who underwent EUS-TA-CFNAN for GSELs showing an HM (GSELHM) on EUS imaging. Immunohistochemical analysis was performed for all EUS-TA-CFNAN and surgically resected specimens. The main outcome measures were the technical results of EUS-TA-CFNAN and the frequency of histological types in GSELHM. Results The endoscopic ultrasound-guided tissue acquisition using conventional fine-needle aspiration needle diagnosis rate for GSELHM was 80.1% (95% confidence interval [CI]: 75.0-84.5, 233/291). It was significantly lower for antrum (P = 0.004) and lesions smaller than 2 cm (P = 0.003). There were no adverse events. The immunohistochemical diagnoses of EUS-TA-CFNAN included 149 cases of gastrointestinal stromal tumour (GIST) (51.2%), 48 cases of leiomyoma (16.5%), 11 cases of schwannoma (3.8%), 8 cases of the ectopic pancreas (2.7%), 5 cases of subepithelial lesion like cancer (1.7%), 12 cases of other lesions (4.1%), and 58 cases of undiagnosable lesions (19.9%). The frequency of malignant or potentially malignant tumour in GSELHM was 55.0% (95% CI: 49.1-60.8, 160/291). Surgery was performed in 149 patients according to the conclusive EUS-TA-CFNAN results, in which the diagnostic accuracy of EUS-TA-CFNAN was 97.3% (95% CI: 94.7-99.9, 145/149). Conclusion The use of EUS-TA-CFNAN for GSELHMs is safe and accurate. Gastric subepithelial lesions showing a hypoechoic mass have a reasonably high possibility of containing malignant or potentially malignant tumours, including GISTs.
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Affiliation(s)
| | | | | | | | - Hidenobu Koga
- Clinical Research Support OfficeAso Iizuka HospitalIizukaJapan
| | - Masafumi Oya
- Department of PathologyAso Iizuka HospitalIizukaJapan
| | | | - Tadashi Koga
- Department of SurgeryAso Iizuka HospitalIizukaJapan
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9
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Hikichi T, Hashimoto M, Yanagita T, Kato T, Nakamura J. Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions. J Med Ultrason (2001) 2024; 51:195-207. [PMID: 37490244 DOI: 10.1007/s10396-023-01342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/26/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the first-choice procedure for obtaining pathological tissue samples from gastrointestinal (GI) subepithelial lesions (SELs). However, its diagnostic accuracy is lower than that for pancreatic masses owing to puncture difficulty and the need for immunostaining for definitive diagnosis. The advent of fine-needle biopsy needles, which have become well known in recent years, improves the diagnostic accuracy of EUS-FNA for GI SELs. The forward-viewing echoendoscope and rapid on-site evaluation (ROSE) have also helped to improve diagnostic accuracy. Furthermore, in facilities where ROSE is not available, endosonographers perform a macroscopic on-site evaluation. With these procedural innovations, EUS-FNA is now performed aggressively even for SELs smaller than 20 mm. The incidence of procedure-related adverse events such as bleeding and infection is low, and thus, EUS-FNA can be safely performed to diagnose SELs.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takumi Yanagita
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Yamamoto M, Nishida T, Uema R, Kanesaka T, Ogawa H, Kitamura S, Iijima H, Nagai K, Tsutsui S, Komori M, Yamamoto K, Tsujii Y, Hayashi Y, Takehara T. Utility and advantage of the unroofing technique for gastrointestinal subepithelial tumors: A multicenter retrospective cohort study. DEN OPEN 2024; 4:e332. [PMID: 38250518 PMCID: PMC10797821 DOI: 10.1002/deo2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
Background and aim Various techniques for direct biopsy from gastrointestinal subepithelial tumors (SETs) have been reported, although no standard method has been established. A common feature of these techniques is the removal of overlaying mucosa to enable direct biopsies from the SETs. These methods have been synthesized under the collective term "unroofing technique". We conducted a multicenter retrospective study to assess its efficacy and identify potential complications. Methods This study was conducted in 10 hospitals and involved all eligible patients who underwent unroofing techniques to obtain biopsies for gastrointestinal SETs between April 2015 and March 2021. The primary endpoint was the diagnostic accuracy of the unroofing technique, and the secondary endpoints were the incidence of adverse events and the factors contributing to the accurate diagnosis. Results The study included 61 patients with 61 gastrointestinal SETs. The median tumor size was 20 mm, and the median procedure time was 38 min, with 82% successful tumor exposure. The rate of pathological diagnosis was 72.1%. In 44 patients with a pathological diagnosis, two showed discrepancies with the postresection pathological diagnosis. No factors, including facility experience, organ, tumor size, or tumor exposure, significantly affected the diagnostic accuracy. There was one case of delayed bleeding and two cases of perforation. Conclusion The diagnostic yield of the unroofing technique was acceptable. The unroofing technique was beneficial regardless of institutional experience, organ, tumor size, or actual tumor exposure.
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Affiliation(s)
- Masashi Yamamoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Ryotaro Uema
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
| | - Takashi Kanesaka
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroyuki Ogawa
- Department of GastroenterologyNishinomiya Municipal Central HospitalHyogoJapan
| | - Shinji Kitamura
- Department of GastroenterologySakai City Medical CenterOsakaJapan
| | - Hideki Iijima
- Department of GastroenterologyOsaka Police HospitalOsakaJapan
| | - Kengo Nagai
- Department of GastroenterologySuita Municipal HospitalOsakaJapan
| | - Shusaku Tsutsui
- Departments of Gastroenterology and HepatologyItami City HospitalHyogoJapan
| | - Masato Komori
- Department of GastroenterologyHyogo Prefectural Nishinomiya HospitalHyogoJapan
| | - Katsumi Yamamoto
- Department of GastroenterologyJapan Community Healthcare Organization Osaka HospitalOsakaJapan
| | - Yoshiki Tsujii
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
| | - Yoshito Hayashi
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
| | - Tetsuo Takehara
- Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan
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11
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Koizumi E, Goto O, Nakagome S, Habu T, Ishikawa Y, Kirita K, Noda H, Higuchi K, Onda T, Akimoto T, Omori J, Akimoto N, Iwakiri K. Technical outcomes and postprocedural courses of mucosal incision-assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video). DEN OPEN 2024; 4:e264. [PMID: 37359151 PMCID: PMC10288069 DOI: 10.1002/deo2.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Objective Mucosal incision-assisted biopsy (MIAB) has been introduced as an alternative to endoscopic ultrasound-guided fine needle aspiration for tissue sampling of subepithelial lesions. However, there have been few reports on MIAB, and the evidence is lacking, particularly in small lesions. In this case series, we investigated the technical outcomes and postprocedural influences of MIAB for gastric subepithelial lesions 10 mm or greater in size. Methods We retrospectively reviewed cases with the intraluminal growth type of possible gastrointestinal stromal tumors, in which MIAB was performed at a single institution between October 2020 and August 2022. Technical success, adverse events, and clinical courses following the procedure were evaluated. Results In 48 MIAB cases with a median tumor diameter of 16 mm, the success rate of tissue sampling and the diagnostic rate were 96% and 92%, respectively. Two biopsies were considered sufficient for making the definitive diagnosis. Postoperative bleeding occurred in one case (2%). In 24 cases, surgery has performed a median of two months after MIAB, and no unfavorable findings caused by MIAB were seen intraoperatively. Finally, 23 cases were histologically diagnosed as gastrointestinal stromal tumors, and no patients who underwent MIAB experienced recurrence or metastasis during a median observation period of 13 months. Conclusions The data indicated that MIAB appears feasible, safe, and useful for histological diagnosis of gastric intraluminal growth types of possible gastrointestinal stromal tumors, even those of a small size. Postprocedural clinical effects were considered negligible.
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Affiliation(s)
- Eriko Koizumi
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Osamu Goto
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
- Division of EndoscopyNippon Medical School HospitalTokyoJapan
| | - Shun Nakagome
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Tsugumi Habu
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Yumiko Ishikawa
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Kumiko Kirita
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Hiroto Noda
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Kazutoshi Higuchi
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Takeshi Onda
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Teppei Akimoto
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Jun Omori
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Naohiko Akimoto
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
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12
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Schroder PM, Biesterveld BE, Al-Adra DP. Premalignant Lesions in the Kidney Transplant Candidate. Semin Nephrol 2024; 44:151495. [PMID: 38490902 DOI: 10.1016/j.semnephrol.2024.151495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
End-stage kidney disease patients who are referred for transplant undergo an extensive evaluation process to ensure their health prior to transplant due in part to the shortage of available organs. Although management and surveillance guidelines exist for malignancies identified in the transplant and waitlist populations, less is written about the management of premalignant lesions in this population. This review covers the less common premalignant lesions (intraductal papillary mucinous neoplasm, gastrointestinal stromal tumor, thymoma, and pancreatic neuroendocrine tumor) that can be found in the transplant candidate population. High-level evidence for the management of these rarer premalignant lesions in the transplant population is lacking, and this review extrapolates evidence from the general population and should not be a substitute for a multidisciplinary discussion with medical and surgical oncologists.
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Affiliation(s)
- Paul M Schroder
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben E Biesterveld
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David P Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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13
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Akahoshi K, Akahoshi K, Shiratsuchi Y, Tamura S, Uemura K, Sashihara R, Ohishi Y, Inoue K, Koga T, Koga H. Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Duodenal Subepithelial Lesions Showing a Hypoechoic Mass on Endoscopic Ultrasound Imaging. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:1156-1162. [PMID: 37681269 PMCID: PMC10724752 DOI: 10.5152/tjg.2023.22696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/16/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND/AIMS For duodenal subepithelial lesions showing a hypoechoic mass on endoscopic ultrasound imaging, the utility of endoscopic ultrasound-guided fine-needle aspiration and the frequency of histological types have not been the focus of previous literature. This study aimed to clarify this. MATERIALS AND METHODS This prospective observational study enrolled 22 consecutive patients who underwent endoscopic ultrasoundguided fine-needle aspiration for duodenal subepithelial lesions with hypoechoic mass on endoscopic ultrasound. Immunohistochemical analysis was performed for all endoscopic ultrasound-guided fine-needle aspiration and surgically resected specimens. The main outcome measures were the technical results of endoscopic ultrasound-guided fine-needle aspiration and the frequency of histological types of duodenal subepithelial lesions with hypoechoic mass. RESULTS Thirteen fine-needle aspiration specimens were obtained from the duodenal bulb and eight from the descending duodenal region. The puncture was not performed because of intervening vessels in one patient. The diagnostic rate was 81% (95% confidence interval: 58.1-94.6, 17/21 patients). In 12 patients receiving surgical resection (excluding one cancellation of endoscopic ultrasoundguided fine-needle aspiration), the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration was 75% (95% confidence interval: 42.8-94.5, 9/12 patients). No complications were observed. The histopathological diagnoses included 11 cases of gastrointestinal stromal tumor (50%), 2 cases of leiomyoma (9%), 2 cases of metastatic cancer (9%), 2 cases of benign inconclusive, and 1 case each of carcinoid, malignant lymphoma, leiomyosarcoma, gauzeoma, and aberrant pancreas (4.5% each). The frequency of malignant tumors in the duodenal subepithelial lesions with hypoechoic mass group was 73% (16/22 patients). CONCLUSIONS Endoscopic ultrasound-guided fine-needle aspiration for duodenal subepithelial lesions with hypoechoic mass was safe and accurate. As duodenal subepithelial lesion with hypoechoic mass has a reasonably high possibility of containing malignant tumors, it is desirable to perform endoscopic ultrasound-guided fine-needle aspiration.
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Affiliation(s)
| | - Kazuya Akahoshi
- Endoscopy Center, Aso Iizuka Hospital, Iizuka, Japan
- Department of Medical Research Promotion, Aso Iizuka Hospital, Iizuka, Japan
| | | | | | - Kento Uemura
- Endoscopy Center, Aso Iizuka Hospital, Iizuka, Japan
| | | | | | - Kanako Inoue
- Division of Central Laboratory, Aso Iizuka Hospital, Iizuka, Japan
| | - Tadashi Koga
- Department of Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Hidenobu Koga
- Department of Medical Research Promotion, Aso Iizuka Hospital, Iizuka, Japan
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14
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Nie WJ, Jing Z, Hua M. Value of enhanced computed tomography in differentiating small mesenchymal tumours of the gastrointestinal from smooth muscle tumours. World J Gastrointest Surg 2023; 15:2012-2020. [PMID: 37901731 PMCID: PMC10600775 DOI: 10.4240/wjgs.v15.i9.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Computed tomography (CT) technology has been gradually used in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours. AIM To explore the value of enhanced CT in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours. METHODS Clinical data of patients with gastric mesenchymal or gastric smooth muscle tumours who were treated in our hospital from May 2018 to April 2023 were retrospectively analysed. Patients were divided into the gastric mesenchymal tumor group and the gastric smooth muscle tumor group respectively (n = 50 cases per group). Clinical data of 50 healthy volunteers who received physical examinations in our hospital during the same period were selected and included in the control group. Serum levels of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), CA-125 and cytokeratin 19 fragment antigen 21-1 were compared among the three groups. The value of CEA and CA19-9 in the identification of gastric mesenchymal tumours was analysed using the receiver operating characteristic (ROC) curve. The Kappa statistic was used to analyse the consistency of the combined CEA and CA19-9 test in identifying gastric mesenchymal tumours. RESULTS CEA levels varied among the three groups in the following order: The gastric mesenchymal tumour group > the control group > the gastric smooth muscle tumour group. CA19-9 levels varied among the three groups in the following order: The gastric mesenchymal group > the gastric smooth muscle group > the control group, the difference was statistically significant (P < 0.05). ROC analysis showed that the area under the curve of CEA and CA19-9 was 0. 879 and 0. 782, respectively. CONCLUSION Enhanced CT has shown value in differentiating small mesenchymal tumors of the stomach and intestines from smooth muscle tumors.
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Affiliation(s)
- Wen-Jun Nie
- Department of Radiology, Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou No. 7 People’s Hospital Radiology Department, Changzhou 213011, Jiangsu Province, China
| | - Zhao Jing
- Medical Area, Eastern Theater General Hospital, Qinhuai District Medical Area, Nanjing 210000, Jiangsu Province, China
| | - Mo Hua
- Department of Radiology, Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou No. 7 People’s Hospital Radiology Department, Changzhou 213011, Jiangsu Province, China
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15
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Zhang S, Huang X, Kang D, Miao J, Zhan Z, Guan G, Chen J, Zhou Y, Li L. Optical second-harmonic generation imaging for identifying gastrointestinal stromal tumors. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2023; 16. [DOI: 10.1142/s1793545823500074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors arising in the digest tract. It brings a challenge to diagnosis because it is asymptomatic clinically. It is well known that tumor development is often accompanied by the changes in the morphology of collagen fibers. Nowadays, an emerging optical imaging technique, second-harmonic generation (SHG), can directly identify collagen fibers without staining due to its noncentrosymmetric properties. Therefore, in this study, we attempt to assess the feasibility of SHG imaging for detecting GISTs by monitoring the morphological changes of collagen fibers in tumor microenvironment. We found that collagen alterations occurred obviously in the GISTs by comparing with normal tissues, and furthermore, two morphological features from SHG images were extracted to quantitatively assess the morphological difference of collagen fibers between normal muscular layer and GISTs by means of automated image analysis. Quantitative analyses show a significant difference in the two collagen features. This study demonstrates the potential of SHG imaging as an adjunctive diagnostic tool for label-free identification of GISTs.
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Affiliation(s)
- Shichao Zhang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, P. R. China
| | - Xingxin Huang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, P. R. China
| | - Deyong Kang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou 350001, P. R. China
| | - Jikui Miao
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, P. R. China
| | - Zhenlin Zhan
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, P. R. China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350001, P. R. China
| | - Jianxin Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, P. R. China
| | - Yongjian Zhou
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, P. R. China
| | - Lianhuang Li
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou 350007, P. R. China
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16
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Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, Triantafyllou K, Facciorusso A, Papanikolaou IS. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics (Basel) 2023; 13:2176. [PMID: 37443568 DOI: 10.3390/diagnostics13132176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Gastric subepithelial lesions (SELs) are intramural lesions that arise underneath the gastric mucosa. SELs can be benign, but can also be malignant or have malignant potential. Therefore, correct diagnosis is crucial. Endosonography has been established as the diagnostic gold standard. Although the identification of some of these lesions can be carried out immediately, solely based on their echo characteristics, for certain lesions histological examination is necessary. Sometimes histology can be inconclusive, especially for smaller lesions. Therefore, new methods have been developed in recent years to assist decision making, such as contrast enhanced endosonography, EUS elastography, and artificial intelligence systems. In this narrative review we provide a complete overview of the gastric SELs and summarize the new data of the last ten years concerning the diagnostic advances of endosonography on this topic.
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Affiliation(s)
- Thomas Vasilakis
- Hepatology and Gastroenterology Clinic, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Dimitrios Ziogas
- 1st Department of Internal Medicine, 251 Hellenic Air Force & VA General Hospital, 3 Kanellopoulou Str., 11525 Athens, Greece
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Eleni Koukoulioti
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christina Kapizioni
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, 71122 Foggia, Italy
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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17
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Manthopoulou E, Ramai D, Ioannou A, Gkolfakis P, Papanikolaou IS, Mangiavillano B, Triantafyllou K, Crinò SF, Facciorusso A. Endoscopic ultrasound-guided tissue acquisition beyond the pancreas. Ann Gastroenterol 2023; 36:257-266. [PMID: 37144012 PMCID: PMC10152811 DOI: 10.20524/aog.2023.0797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023] Open
Abstract
Endoscopic ultrasound (EUS) offers the ability to obtain tissue material via a fine needle under direct visualization for cytological or pathological examination. Prior studies have looked at EUS tissue acquisition; however, most reports have been centered around lesions of the pancreas. This paper aims to review the literature on EUS tissue acquisition in other organs (beyond the pancreas) such as the liver, biliary tree, lymph nodes, and upper and lower gastrointestinal tracts. Furthermore, techniques for obtaining tissue samples under EUS guidance continue to evolve. Specifically, some of the techniques that endoscopists employ are suction techniques (i.e., dry heparin, dry suction technique, wet suction technique), the slow pull technique, and the fanning technique. Apart from acquisition techniques, the type and size of the needle utilized play a major role in the quality of samples. This review describes the indications for tissue acquisition for each organ, and also describes and compares the various tissue acquisition techniques, as well as the different needles used according to their shape and size.
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Affiliation(s)
- Eleni Manthopoulou
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Greece (Eleni Manthopoulou)
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai)
| | - Alexandros Ioannou
- Gastroenterology Department, Alexandra General Hospital, Athens, Greece (Alexandros Ioannou)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium (Paraskevas Gkolfakis)
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA), Italy (Benedetto Mangiavillano)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy (Stefano Francesco Crinò)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy (Antonio Facciorusso)
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18
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Pallio S, Crinò SF, Maida M, Sinagra E, Tripodi VF, Facciorusso A, Ofosu A, Conti Bellocchi MC, Shahini E, Melita G. Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours. Cancers (Basel) 2023; 15:1285. [PMID: 36831627 PMCID: PMC9954263 DOI: 10.3390/cancers15041285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Gastrointestinal Stromal Tumors (GISTs) are subepithelial lesions (SELs) that commonly develop in the gastrointestinal tract. GISTs, unlike other SELs, can exhibit malignant behavior, so differential diagnosis is critical to the decision-making process. Endoscopic ultrasound (EUS) is considered the most accurate imaging method for diagnosing and differentiating SELs in the gastrointestinal tract by assessing the lesions precisely and evaluating their malignant risk. Due to their overlapping imaging characteristics, endosonographers may have difficulty distinguishing GISTs from other SELs using conventional EUS alone, and the collection of tissue samples from these lesions may be technically challenging. Even though it appears to be less effective in the case of smaller lesions, histology is now the gold standard for achieving a final diagnosis and avoiding unnecessary and invasive treatment for benign SELs. The use of enhanced EUS modalities and elastography has improved the diagnostic ability of EUS. Furthermore, recent advancements in artificial intelligence systems that use EUS images have allowed them to distinguish GISTs from other SELs, thereby improving their diagnostic accuracy.
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Affiliation(s)
- Socrate Pallio
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | | | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45201, USA
| | | | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology—IRCCS “Saverio de Bellis” Castellana Grotte, 70013 Castellana Grotte, Italy
| | - Giuseppinella Melita
- Human Pathology of Adult and Child Department, University of Messina, 98100 Messina, Italy
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19
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Yue L, Sun Y, Wang X, Hu W. Advances of endoscopic and surgical management in gastrointestinal stromal tumors. Front Surg 2023; 10:1092997. [PMID: 37123546 PMCID: PMC10130460 DOI: 10.3389/fsurg.2023.1092997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
As one of the most common mesenchymal malignancies in the digestive system, gastrointestinal stromal tumors (GISTs) occur throughout the alimentary tract with diversified oncological characteristics. With the advent of the tyrosine kinase inhibitor era, the treatment regimens of patients with GISTs have been revolutionized and GISTs have become the paradigm of multidisciplinary therapy. However, surgery resection remains recognized as the potentially curative management for the radical resection and provided with favorable oncological outcomes. The existing available surgery algorithms in clinical practice primarily incorporate open procedure, and endoscopic and laparoscopic surgery together with combined operation techniques. The performance of various surgery methods often refers to the consideration of risk evaluation of recurrence and metastases; the degree of disease progression; size, location, and growth pattern of tumor; general conditions of selected patients; and indications and safety profile of various techniques. In the present review, we summarize the fundamental principle of surgery of GISTs based on risk assessment as well as tumor size, location, and degree of progress with an emphasis on the indications, strengths, and limitations of current surgery techniques.
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Affiliation(s)
- Lei Yue
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Yingchao Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Xinjie Wang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
- Zhejiang University Cancer Center, Hangzhou, China
- Correspondence: Weiling Hu
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Peng MS, Zeng HT, Zhang ZL, Chen ZM, Long T, Wang LS, Xu ZL. Efficacy and safety of endoscopic "calabash" ligation and resection for small gastric stromal tumors originating from the muscularis propria. Cancer Med 2022; 12:6825-6841. [PMID: 36510478 PMCID: PMC10067037 DOI: 10.1002/cam4.5471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/26/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022] Open
Abstract
AIM We compared endoscopic "calabash" ligation and resection (ECLR) and endoscopic submucosal excision (ESE) in treating endophytic gastric stromal tumors (GSTs) ≤15 mm in diameter originating from the muscularis propria. METHODS We performed a retrospective study and included patients who visited our hospital for removal of small endophytic GSTs (diameter ≤ 15 mm) confirmed by postoperative pathological reports between February 2019 and December 2020. Patients were assigned to the study (received ECLR) or control (accepted ESE) groups, and their medical records were reviewed. Age, sex, GST size, resection outcomes, procedure measurements, lengths of hospital stays, medical expenses, intraoperative and postoperative complications, and follow-up outcomes were documented and compared between the two groups. Propensity score matching was used to avoid retrospective biases. RESULTS A total of 277 patients were included in the analysis, with 135 in the study group and 142 in the control group. After propensity score matching, 119 cases in each group were finally included in the study. Compared to the control group, the study group had significantly shorter procedure durations and lengths of hospital stays, as well as reduced medical expenses. Compared to the control group, the study group also had significantly lower incidence rates of intraoperative stomach perforation, postoperative intraperitoneal infection, and postoperative electrocoagulation syndrome, as well as a lower intensity of postoperative pain. There were no significant differences in the other measurements between the two groups. CONCLUSION ECLR is an effective and safe procedure for treating patients with endophytic GSTs ≤15 mm in diameter originating from the muscularis propria.
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Affiliation(s)
- Min-Si Peng
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong Province, China
| | - Hao-Tian Zeng
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong Province, China
| | - Zhu-Liang Zhang
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong Province, China
| | - Ze-Ming Chen
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong Province, China
| | - Ting Long
- Department of Pathology The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, Guangdong Province, China
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21
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Comparison of 22G Fork-Tip and Franseen Needles and Usefulness of Contrast-Enhanced Endoscopic Ultrasound for Diagnosis of Upper Gastrointestinal Subepithelial Lesions. Diagnostics (Basel) 2022; 12:diagnostics12123122. [PMID: 36553129 PMCID: PMC9776934 DOI: 10.3390/diagnostics12123122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) is less accurate in obtaining samples from gastrointestinal subepithelial lesions (SELs) ≤2 cm than from pancreatic cancers. The present study compared the usefulness of 22G Fork-tip and Franseen needles for EUS-TA and assessed the ability of contrast-enhanced harmonic EUS (CH-EUS) to diagnose SELs ≤2 cm. Fifty-seven patients who underwent EUS-TA for SELs ≤2 cm were evaluated. The primary endpoint was to compare the rate of acquisition of sufficient samples by these two needles. Secondary endpoints included technical success rate, adverse events, numbers of needle passes, and diagnostic ability of CH-EUS for SELs. Of the 57 included patients, 23 and 34 underwent EUS-TA with Fork-tip and Franseen needles, respectively. Technical success rates were 100% with both needles and adverse events occurred in zero (0%) and one (2.9%) patient with Fork-tip and Franseen needles, respectively. The rate of adequate sample acquisition was significantly higher using Fork-tip than Franseen needles (96% vs. 74%; p = 0.038). The hyper- or iso-vascular pattern on CH-EUS correlated significantly with a diagnosis of gastrointestinal stromal tumor (p < 0.001). EUS-TA with Fork-tip needles were superior to EUS-TA with Franseen needles in acquiring sufficient samples and CH-EUS was also useful for the diagnosis of SELs ≤2 cm.
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22
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Li C, Zhang XW, Zhao CA, Liu M. Abdominal bronchogenic cyst: A rare case report. World J Clin Cases 2022; 10:12671-12677. [PMID: 36579087 PMCID: PMC9791524 DOI: 10.12998/wjcc.v10.i34.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/29/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Bronchogenic cysts are cystic masses caused by congenital abnormal development of the respiratory system, and usually occur in the pulmonary parenchyma or mediastinum.
CASE SUMMARY A rare case of a bronchogenic cyst discovered in the abdominal cavity of a 35-year-old man is reported. Physical examination found a space-occupying lesion in the patient’s abdomen for 4 d. Laparoscopic exploration found the cyst tightly adhered to the stomach and its peripheral blood vessels; therefore, intraoperative laparotomy was performed. The cystic mass was resected en bloc with an Endo-GIA stapler. The final postoperative pathological diagnosis confirmed an abdominal bronchogenic cyst.
CONCLUSION This is a rare case of a bronchogenic cyst that was discovered within the abdominal cavity of a male patient. The cyst is easily confused with or misdiagnosed as other lesions. Therefore, it is necessary to distinguish abdominal bronchogenic cyst from gastrointestinal stromal tumor, Meckel’s diverticulum, enteric duplication cyst, or lymphangioma. Although computer tomography and magnetic resonance imaging were the primary diagnostic approaches, endoscopic ultrasound-guided fine-needle aspiration could assist with clarification of the cytological or histopathological diagnosis before surgery.
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Affiliation(s)
- Chao Li
- School of Public Health, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of General Surgery, Xi’an Gaoxin Hospital, Xi'an 710075, Shaanxi Province, China
| | - Xin-Wei Zhang
- Department of Thoracic Surgery, Shaanxi Provincial Cancer Hospital, Xi’an 710061, Shaanxi Province, China
| | - Chang-An Zhao
- Department of Pathology, School of Basic Medical Science, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Min Liu
- Department of General Surgery, Xi’an Gaoxin Hospital, Xi'an 710075, Shaanxi Province, China
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23
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Wang X, Abi-Raad R, Tang H, Cai G. Ki-67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification. Cancer Cytopathol 2022; 130:974-982. [PMID: 35876606 DOI: 10.1002/cncy.22630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/12/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Risk assessment of gastrointestinal stromal tumor (GIST) is challenging on cytology specimens. This study aims to determine whether Ki-67 index evaluated on fine-needle aspiration (FNA) specimens can correlate with the mitotic rate of GIST in surgical specimens and provide further risk assessment. METHODS Cases with cell blocks containing adequate tumor cells and surgical resections were included. Ki-67 immunostain was retrospectively performed on cell block sections, and Ki-67 index was calculated on the "hot spot" areas. RESULTS This study included 50 GIST cases from stomach (n = 45; 90%), duodenum (n = 4; 8%), and distal esophagus (n = 1; 2%). The tumor size ranged from 1.5 cm to 21 cm (mean, 5.4 cm). Based on the mitotic count, 37 GISTs (74%) had low mitotic rate (LMR) and 13 GISTs (26%) had high mitotic rate (HMR). The spindle cell, epithelioid, and mixed types accounted for 60%, 14%, and 26% of GIST, respectively. Ki-67 index counted on cell block sections correlated well with mitotic count evaluated in surgical specimens (r = 0.8031). Mean Ki-67 index was higher in HMR than LMR groups (3.5% vs. 1%, p < .001). The receiver operating characteristic curve using Ki-67 index to predict mitotic rate was further analyzed, and area under the curve was 0.839. Using a cutoff of 2.5% yielded a sensitivity of 70% at 92% specificity. CONCLUSIONS This study demonstrates good correlations between Ki-67 index and mitotic count or risk stratification, suggesting that Ki-67 index evaluated on cytology specimens may offer a promising approach to preoperatively predict the mitotic rate and risk of GIST.
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Affiliation(s)
- Xi Wang
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Haiming Tang
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
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24
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Ishiguro Y, Uchimura K, Furuse H, Imabayashi T, Matsumoto Y, Watanabe S, Tsuchida T. Esophageal submucosal tumor diagnosed with EBUS-guided transbronchial mediastinal cryobiopsy: A case report. Thorac Cancer 2022; 13:3068-3072. [PMID: 36100954 PMCID: PMC9626318 DOI: 10.1111/1759-7714.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 01/07/2023] Open
Abstract
Cryobiopsy is advantageous for collecting larger specimens with minimum crushing compared to forceps biopsy and transbronchial needle aspiration (TBNA), but it has not been widely used for mediastinal tumors. In this report, a leiomyoma of the thoracic esophagus was diagnosed with endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-cryo). An asymptomatic 49-year-old woman had a 2.6-cm sized submucosal tumor (SMT) of the esophagus adjacent to the trachea and left main bronchus. EBUS-TBNA and EBUS-guided intranodal forceps biopsy were performed, followed by EBUS-cryo. The biopsy forceps could not be inserted into the tumor, but the cryoprobe was smoothly inserted. EBUS-TBNA could not obtain enough spindle-shaped tumor cells for immunohistochemical staining, but EBUS-cryo provided sufficient specimens for diagnosing the leiomyoma. Adding EBUS-cryo to EBUS-TBNA has recently been reported to achieve high diagnostic yields for lymphomas, uncommon tumors, and benign diseases. EBUS-cryo seems a valid diagnostic option for esophageal SMTs that are difficult to diagnose with needles and forceps.
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Affiliation(s)
- Yuki Ishiguro
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan,Department of Thoracic SurgeryNational Cancer Center HospitalTokyoJapan
| | - Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Hideaki Furuse
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan,Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | | | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
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25
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Ge QC, Wu YF, Liu ZM, Wang Z, Wang S, Liu X, Ge N, Guo JT, Sun SY. Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors. World J Gastroenterol 2022; 28:5457-5468. [PMID: 36312832 PMCID: PMC9611709 DOI: 10.3748/wjg.v28.i37.5457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) with a diameter of < 2 cm are called small GISTs. Currently, endoscopic ultrasound (EUS) is widely used as a regular follow-up method for GISTs, which can also provide a preliminary basis for judging the malignancy potential of lesions. However, there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.
AIM To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.
METHODS We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019. The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery. Preoperative EUS features (marginal irregularity, cystic changes, homogeneity, ulceration, and strong echogenic foci) were retrospectively analyzed. The assessment results based on EUS features were compared with the pathological features.
RESULTS A total of 256 patients (69 men and 187 women) were enrolled. Pathological results included 232, 16, 7, and 1 very low-, low-, intermediate-, and high-risk cases, respectively. The most frequent tumor location was the gastric fundus (78.1%), and mitoses were calculated as > 5/50 high power field in 8 (3.1%) patients. Marginal irregularity, ulceration, strong echo foci, and heterogeneity were detected in 1 (0.4%), 2 (0.8%), 22 (8.6%), and 67 (65.1%) patients, respectively. However, cystic changes were not detected. Tumor size was positively correlated with the mitotic index (P < 0.001). Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential (95% confidence interval: 0.824–0.956). EUS heterogeneity with tumor diameters > 1.48 cm was associated with higher risk classification (P < 0.05).
CONCLUSION Small GISTs (diameters > 1.48 cm) with positive EUS features should receive intensive surveillance or undergo endoscopic surgery. EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.
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Affiliation(s)
- Qi-Chao Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu-Fan Wu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zi-Ming Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiang Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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26
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Utility of PET Scans in the Diagnosis and Management of Gastrointestinal Tumors. Dig Dis Sci 2022; 67:4633-4653. [PMID: 35908126 DOI: 10.1007/s10620-022-07616-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
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Beji H, Bouassida M, Mroua B, Belfkih H, M'farrej MK, Touinsi H. Extra-gastrointestinal stromal tumor of the pancreas: A case report. Int J Surg Case Rep 2022; 98:107581. [PMID: 36057252 PMCID: PMC9482973 DOI: 10.1016/j.ijscr.2022.107581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction Presentation of case Clinical discussion Conclusion
Pancreatic EGIST is extremely rare. There are no specific clinical and radiologic findings. Surgical resection is the cornerstone of the treatment. Whenever possible, enucleation is sufficient.
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28
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Giri S, Afzalpurkar S, Angadi S, Sundaram S. Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis. Clin Endosc 2022; 55:615-625. [PMID: 36205045 PMCID: PMC9539302 DOI: 10.5946/ce.2022.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIMS Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis. METHODS A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs. RESULTS Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events. CONCLUSION MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.
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Affiliation(s)
| | - Shivaraj Afzalpurkar
- Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India
| | | | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
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29
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Lee JS, Cho CM, Kwon YH, Seo AN, Bae HI, Han MH. Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors. Clin Endosc 2022; 55:637-644. [PMID: 35973440 PMCID: PMC9539288 DOI: 10.5946/ce.2021.257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs. Methods In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques. Results The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis. Conclusions SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.
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Affiliation(s)
- Joon Seop Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chang Min Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - An Na Seo
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Han Ik Bae
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Man-Hoon Han
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
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30
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Tominaga S, Kobayashi M, Maruyama A, Yano M. Endoscopic cutting-wave biopsy for submucosal tumors smaller than 20 mm. Endoscopy 2022; 54:E439-E440. [PMID: 34535033 DOI: 10.1055/a-1625-2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Shintaro Tominaga
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
| | - Makoto Kobayashi
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
| | - Akihiro Maruyama
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
| | - Motoyoshi Yano
- Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
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31
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Kasuga N, Kurita Y, Tanida E, Yagi S, Suzuki K, Hasegawa S, Sato T, Hosono K, Kato S, Sekino Y, Kobayashi N, Endo I, Kubota K, Nakajima A. Franseen Needles May Be Promising for Improving the Sampling Adequacy of EUS-FNA for Subepithelial Lesions. Diagnostics (Basel) 2022; 12:diagnostics12071667. [PMID: 35885571 PMCID: PMC9322475 DOI: 10.3390/diagnostics12071667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for SELs with Franseen needles. This retrospective study enrolled 130 patients who underwent EUS-FNA with a 22-gauge needle for SELs from January 2010 to March 2021. We compared sampling adequacy and predictive factors influencing the sampling adequacy of EUS-FNA for SELs between Franseen and conventional needles. The sampling adequacy rates were 95.0% (38/40) with Franseen needles and 76.7% (69/90) with conventional needles (p = 0.011). The mean number of punctures with Franseen needles (2.80) was significantly less than that with conventional needles (3.42) (p < 0.001). In the multivariate analysis, the use of Franseen needles (p = 0.029; odds ratio [OR], 5.37; 95% confidence interval [CI], 1.18−23.36) was an independent factor influencing the sampling adequacy. Compared to conventional needles, the Franseen needle could play a vital role in accurately diagnosing SELs by yielding better sampling adequacy and reducing the number of passes.
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Affiliation(s)
- Noriki Kasuga
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
- Department of Gastroenterology, Machida Municipal Hospital, Tokyo 194-0023, Japan;
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
- Correspondence: ; Tel.: +81-45-787-2640; Fax: +81-45-784-3546
| | - Emiko Tanida
- Department of Gastroenterology, Machida Municipal Hospital, Tokyo 194-0023, Japan;
| | - Shin Yagi
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Ko Suzuki
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Sho Hasegawa
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Takamitsu Sato
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Yusuke Sekino
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama 222-0036, Japan;
| | - Noritoshi Kobayashi
- Department of Oncology, Yokohama City University Hospital, Yokohama 236-0004, Japan;
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Hospital, Yokohama 236-0004, Japan;
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (N.K.); (S.Y.); (K.S.); (S.H.); (T.S.); (K.H.); (S.K.); (K.K.); (A.N.)
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Jakob J, Salameh R, Wichmann D, Charalambous N, Zygmunt AC, Kreisel I, Heinz J, Ghadimi M, Ronellenfitsch U. Needle tract seeding and abdominal recurrence following pre-treatment biopsy of gastrointestinal stromal tumors (GIST): results of a systematic review. BMC Surg 2022; 22:202. [PMID: 35597932 PMCID: PMC9124402 DOI: 10.1186/s12893-022-01648-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are rare abdominal tumors. Pretreatment biopsies may be used to diagnose a GIST and enable tailored treatment. Some experts are skeptical about biopsies because they fear tumor cell seeding. The objective of this study was to determine if pretreatment biopsy is associated with increased tumor recurrence. METHODS We performed a systematic literature search and included studies assessing the oncological outcome of GIST patients who underwent a pre-treatment core needle biopsy or fine needle aspiration. We assessed methodological quality with the Newcastle-Ottawa-Scale for non-randomized studies. This review was registered in the PROSPERO database (CRD42021170290). RESULTS Three non-randomized studies and eight case reports comprising 350 patients were eligible for inclusion. No prospective study designed to answer the review question was found. One case of needle tract seeding after percutaneous core needle biopsy of GIST was reported. None of the studies reported an increased rate of abdominal recurrence in patients with pretreatment biopsy. CONCLUSIONS The existing evidence does not indicate a relevant risk of needle tract seeding or abdominal recurrence after pre-treatment biopsy of GIST. Biopsy can safely be done to differentiate GIST from other tumors and to select the most appropriate treatment.
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Affiliation(s)
- Jens Jakob
- Department of Surgery, Sarcoma Unit, University Medical Center Mannheim, Th.-Kutzer-Ufer 1-3, 68163, Mannheim, Germany.
| | - Rashad Salameh
- Department of Visceral, Thoracic, Vascular and Transplant Surgery, University Hospital Dresden, Dresden, Germany
| | - David Wichmann
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Germany
| | - Nicos Charalambous
- Department of Visceral, Thoracic, Vascular and Transplant Surgery, University Hospital Dresden, Dresden, Germany
| | - Anne-Christine Zygmunt
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Germany
| | - Inga Kreisel
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Germany
| | - Judith Heinz
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Germany
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Hu J, Sun X, Ge N, Wang S, Guo J, Liu X, Wang G, Sun S. The necessarity of treatment for small gastric subepithelial tumors (1-2 cm) originating from muscularis propria: an analysis of 972 tumors. BMC Gastroenterol 2022; 22:182. [PMID: 35410177 PMCID: PMC9004094 DOI: 10.1186/s12876-022-02256-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background and objectives Up till now, there are still controversies about the specific indication of endoscopic resection for small gastric subepithelial tumors (gSETs) originating from muscularis propria. We aimed to investigate the safety of endoscopic resection and postoperative pathology analysis.
Method The patients with primary small gSETs originating from muscularis propria, treated by endoscopic resection in the endoscopic center of Shengjing Hospital between January, 2011 and September, 2019 were enrolled. The complete resection rate, adverse events and clinicopathological features were recorded. Result A total of 936 patients with 972 gastric SETs ≤ 2 cm originating from muscularis propria were included in our study. All the lesions were successfully treated by endoscopic resection. Nearly half of lesions were proved to be gastrointestinal stromal tumor (GIST) [n = 411 (42.3%)] according to postoperative pathology. All the objects were further subdivided into 2 groups, ≤ 1 cm, > 1 and ≤ 2 cm gSETs. The risk of gastric GIST of intermediate/high risk in the group (> 1 and ≤ 2 cm gSETs) is 8.41 times as that of gastric GIST in the group (the size of gastric ≤ 1 cm gSETs) (P < 0.05). Conclusion Endoscopic resection is a safe and effective treatment for small gSETs. gSETs (1–2 cm) is more risky than gSETs (≤ 1 cm) and should be resected. This should be evaluated by further studies.
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Affiliation(s)
- Jinlong Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xinzhu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jintao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xiang Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Guoxin Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12040810. [PMID: 35453857 PMCID: PMC9027519 DOI: 10.3390/diagnostics12040810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.
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Sekine M, Miura T, Fujiwara J, Uehara T, Asano T, Matsumoto S, Miyatani H, Mashima H. Utility of endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for diagnosing small subepithelial lesions (< 20 mm). J Ultrasound 2022; 25:35-40. [PMID: 33511507 PMCID: PMC8964910 DOI: 10.1007/s40477-020-00548-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/04/2020] [Indexed: 11/03/2022] Open
Abstract
AIM Subepithelial lesions (SELs) are defined as being located under the mucosa. Presently, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is commonly performed to diagnose SELs. With the development of new puncture needles, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB), which allows for the acquisition of large tissue samples, has been proposed. However, studies on EUS-FNB of SELs measuring < 20 mm have not yielded satisfactory results. Therefore, we aimed to assess the performance and usefulness of EUS-FNB of SELs measuring less than < 20 mm. METHODS The present study included 62 patients who underwent EUS-FNA or EUS-FNB for SELs at our hospital between January 2015 and March 2019. EUS-FNA was performed using fine-needle aspiration needles, and EUS-FNB was performed using fine-needle biopsy needles. These needles, which come in different shapes and diameters, were compared in terms of their usefulness in performing procedures for SELs measuring ≥ 20 mm and those measuring < 20 mm. RESULTS For SELs measuring ≥ 20 mm, the use of needles with a large diameter, such as 19 or 20 G, resulted in significantly improved diagnostic rates. For SELs measuring < 20 mm, the use of FNB needles showed significantly improved diagnostic rates, regardless of the size of the puncture needles. CONCLUSION Even when SELs are less than 20 mm, they might have malignant potential, and histological diagnosis may be desirable in some cases. EUS-FNB has an advantage over EUS-FNA in the diagnosis of SELs measuring < 20 mm.
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Affiliation(s)
- Masanari Sekine
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan.
| | - Takaya Miura
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Junichi Fujiwara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takeharu Asano
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
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Nagai K, Sofuni A, Tsuchiya T, Kono S, Ishii K, Tanaka R, Tonozuka R, Mukai S, Yamamoto K, Matsunami Y, Asai Y, Kurosawa T, Kojima H, Yamaguchi H, Nagao T, Itoi T. Efficacy of the Franseen needle for diagnosing gastrointestinal submucosal lesions including small tumors. Endosc Ultrasound 2021; 10:424-430. [PMID: 34975040 PMCID: PMC8785670 DOI: 10.4103/eus-d-21-00035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and Objectives: Several studies have demonstrated that EUS-guided fine-needle biopsy (EUS-FNB) is useful for diagnosing gastrointestinal subepithelial lesions (GI SELs). However, there is limited evidence regarding the use of Franseen needles during EUS-FNB for patients with GI SELs. In addition, the optimal approach for diagnosing small SELs is unclear. This study aimed to evaluate whether EUS-FNB using a Franseen needle was effective for diagnosing GI SELs, including small lesions. Methods: Between January 2013 and January 2020, 150 consecutive patients with GI SELs underwent EUS-FNA/FNB to achieve a histological diagnosis. Eighty-six consecutive patients who underwent EUS-FNB using a Franseen needle were compared to 64 patients who underwent EUS-FNA using a conventional needle. Results: The diagnostic yield was significantly higher using a Franseen needle than using a conventional needle (85% vs. 75%, P = 0.006). Furthermore, in cases with SELs that were <20 mm, the diagnostic yield was significantly higher using a Franseen needle than using a conventional needle (81% vs. 45%; P = 0.003). Multivariate analysis revealed that obtaining a sufficient diagnostic sample was independently predicted by Franseen needle use (adjusted odds ratio: 2.8, 95% confidence interval: 1.2–6.3; P = 0.01) and tumor size of >20 mm (adjusted odds ratio: 3.4, 95% confidence interval: 1.4–8.2; P = 0.006). Conclusion: Even when attempting to diagnose small GI SELs, EUS-FNB using a Franseen needle appears to provide a more efficient acquisition of true histological core tissue than using a conventional needle.
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Affiliation(s)
- Kazumasa Nagai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shin Kono
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yasutsugu Asai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Kurosawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Kojima
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Yamaguchi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Suzuki M, Sekino Y, Hosono K, Kawana K, Nagase H, Kubota K, Nakajima A. Optimal number of needle punctures in endoscopic ultrasound-guided fine-needle biopsy for gastric subepithelial lesions without rapid on-site evaluation. J Med Ultrason (2001) 2021; 48:623-629. [PMID: 34463865 DOI: 10.1007/s10396-021-01129-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The utility of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for gastric subepithelial lesions (SELs) has been reported. In this study, we examined the optimal number of needle punctures during EUS-FNB for gastric SELs without rapid on-site evaluation (ROSE). The factors that allowed for a single needle puncture to arrive at the correct diagnosis were also analyzed. METHODS We conducted a retrospective study of all patients who underwent EUS-FNB to evaluate gastric SELs between April 2015 and September 2020; 51 patients with 57 gastric SELs were enrolled. The optimal number of needle punctures was determined when additional needle passes did not increase diagnostic sensitivity by more than 10%. Factors allowing for only a single needle puncture to arrive at the correct diagnosis were identified by univariate and multivariate logistic regression analyses. RESULTS EUS-FNB resulted in a definitive final diagnosis in 48 of 57 lesions (84%). Lesions in the gastric body (odds ratio [OR] 6.15, 95% confidence interval [CI] 1.75-21.6; P < 0.01) and lesions punctured using a 22G Franseen needle (OR 3.61, 95% CI 1.07-12.3; P = 0.04) were independent factors that allowed for only a single needle puncture to arrive at the correct diagnosis. The optimal number of needle punctures for lesions using a 22G Franseen needle in the gastric body and other lesions was two and three, respectively. CONCLUSION The optimal number of needle punctures in EUS-FNB for gastric SELs without ROSE was two or three, depending on the location and type of needle used.
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Affiliation(s)
- Masato Suzuki
- Department of Gastroenterology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, 222-0036, Japan.,Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yusuke Sekino
- Department of Gastroenterology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, 222-0036, Japan.
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kenichi Kawana
- Department of Gastroenterology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, 222-0036, Japan
| | - Hajime Nagase
- Department of Gastroenterology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, 222-0036, Japan
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Christensen AW, Goldberg AF. Mitotic count of fine needle aspiration material of gastrointestinal stromal tumours of the stomach underestimates actual mitotic count. Cytopathology 2021; 33:100-106. [PMID: 34390589 DOI: 10.1111/cyt.13050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A mitotic count is required for histological grading in resections of gastrointestinal stromal tumours (GISTs). However, no consensus on the utility of mitotic count in fine needle aspiration (FNA) GIST material currently exists. This study examines the relationship between mitotic counts of FNAs and subsequent resections of GISTs of the stomach. MATERIALS AND METHODS We identified 39 cases of GISTs of the stomach diagnosed via FNA at our institution between January 1, 2014, and December 31, 2019, with subsequent resection. We noted if rapid on-site evaluation (ROSE) was performed. Cell block (CB) material from FNAs was analysed for total area, percentage containing neoplastic cells, and number of mitoses. We compared the mitotic counts in CBs and subsequent resections with t tests. RESULTS ROSE was performed in 82% of cases and called adequate every time. Mean values for total CB area, neoplastic material percentage, and area of neoplastic cells were 54.7 mm2 (range 1-986), 45% (range 10%-90%), and 19.2 mm2 , respectively; 27 cases (69%) had greater than 50 high powered fields of GIST material in the CB. Mean numbers of mitoses per 5 mm2 were 0.38 (range 0-11) for CBs versus 5.92 (range 0-70) for resections (P < 0.05). CONCLUSION At our institution, ROSE adequacy of spindle cell lesions focuses on diagnosing GIST rather than obtaining adequate material for histological grading. Mitotic figures were statistically lower in FNA CB material than subsequent resections, and using mitotic counts from CB material may underestimate the histological grade of GISTs of the stomach.
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Affiliation(s)
- Aaron W Christensen
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allison F Goldberg
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Panbude SN, Ankathi SK, Ramaswamy AT, Saklani AP. Gastrointestinal Stromal Tumor (GIST) from esophagus to anorectum - diagnosis, response evaluation and surveillance on computed tomography (CT) scan. Indian J Radiol Imaging 2021; 29:133-140. [PMID: 31367084 PMCID: PMC6639866 DOI: 10.4103/ijri.ijri_354_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal stromal tumor (GIST) are the most common non epithelial tumor of the gastrointestinal (GI) tract. They arise from interstitial cells of Cajal present in the myenteric plexus. They can also arise outside the GI tract from mesentery, retro peritoneum and omentum. With the advent of new targeted molecular therapy c- tyrosine kinase inhibitor (Imatinib), it has become important to differentiate between response and pseudo-progression of the disease as response evaluation criteria for GIST are different from Response Evaluation Criteria in Solid Tumors (RECIST). Purpose of this pictorial essay is to enumerate the characteristic CT features of GIST, and discuss atypical features and response evaluation criteria.
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Affiliation(s)
- Sushil N Panbude
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suman K Ankathi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant T Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Avanish P Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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40
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Chen ZM, Peng MS, Wang LS, Xu ZL. Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review. World J Gastrointest Oncol 2021; 13:462-471. [PMID: 34163567 PMCID: PMC8204354 DOI: 10.4251/wjgo.v13.i6.462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/04/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e., those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?
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Affiliation(s)
- Ze-Ming Chen
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Min-Si Peng
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
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Hashimoto C, Hikichi T, Hashimoto M, Waragai Y, Takasumi M, Nakamura J, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Satake S, Kobayakawa M, Hashimoto Y, Ohira H. Localized gastric amyloidosis diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:1036-1041. [PMID: 33886105 DOI: 10.1007/s12328-021-01416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
A 49-year-old man was found to have an elevated lesion on esophagogastroduodenoscopy (EGD) for gastric cancer screening. This lesion had been noted in EGD 13 years earlier, but the patient had not received EGD since then. Endoscopy showed a relatively soft subepithelial lesion (SEL) in the gastric antrum. In addition, endoscopic ultrasonography (EUS) showed a 20-mm-sized, slightly non-uniform hypoechoic mass in the submucosa. Since the diagnosis could not be confirmed by mucosal biopsy, EUS-guided fine-needle aspiration (EUS-FNA) was performed. Hematoxylin-eosin staining of EUS-FNA samples revealed deposition of acidophilic unstructured materials. The structure was positive on Congo red staining, and green polarized light was also observed under a polarizing microscope. Moreover, it was resistant to potassium permanganate reaction, negative for serum amyloid A protein, positive for anti-λ chain antibody, and negative for anti-κ chain, anti-amyloid A, anti-transthyretin, and anti-β2-microglobulin antibodies. Therefore, the lesion was diagnosed as AL-λ-type amyloidosis. No systemic amyloidosis findings were found; thus, the patient was finally diagnosed with localized gastric AL amyloidosis. If an SEL is seen without disease-specific endoscopic findings, amyloidosis should be included in the differential diagnosis, and EUS-FNA can contribute to obtaining tissue samples in such cases.
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Affiliation(s)
- Choichiro Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
| | - Minami Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuichi Waragai
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mika Takasumi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshinori Okubo
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shunsuke Satake
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Hernandez-Lara AH, de Paredes AGG, Song LMWK, Rowan DJ, Graham RP, Levy MJ, Gleeson FC, Kamboj AK, Mara KC, Abu-Dayyeh BK, Chandrasekhara V, Iyer PG, Storm AC, Rajan E. Outcomes of endoscopic ultrasound and endoscopic resection of gastrointestinal subepithelial lesions: a single-center retrospective cohort study. Ann Gastroenterol 2021; 34:516-520. [PMID: 34276190 PMCID: PMC8276353 DOI: 10.20524/aog.2021.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background Endoscopic resection (ER) is an emerging therapeutic alternative for subepithelial gastrointestinal lesions (SELs). We aimed to determine whether size, layer of origin, and histology based on endoscopic ultrasound (EUS) and EUS-guided sampling (EUS-GS) influenced the outcomes and selection of patients for ER. Methods We performed a retrospective review of patients who underwent EUS, EUS-GS and resection of SELs from 2012-2019. Two pathologists reviewed the histology and layer of origin of all resected specimens, serving as the criterion for EUS accuracy. Results Seventy-three patients were included, of whom 59 (81%) were gastric SELs. Per EUS, median lesion size was 21 mm (interquartile range 15-32), and 63 (86%) originated from the 4th layer. The overall accuracy of EUS and EUS-GS in predicting the layer of origin and histology was 88% (95% confidence interval [CI] 77-94%) and 96% (95%CI 87-98%), respectively. Based on EUS, 18 (25%) patients were referred for ER, 5 (7%) to laparoscopic-endoscopic cooperative surgery, and 50 (68%) to surgery. Size >20 mm was associated with the type of resection approach (P=0.005), while layer of origin and histology were not (P=0.06 and P=0.09, respectively). When SELs were inaccurately classified (n=4) there were no adverse events or revision of the resection approach. Conclusions EUS plays an important role in the outcome of resection approach for SELs, with size significantly influencing the selection for ER. In patients undergoing ER, no revised resections were needed when EUS was inaccurate.
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Affiliation(s)
- Ariosto H Hernandez-Lara
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Ana Garcia Garcia de Paredes
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Daniel J Rowan
- Department of Anatomic Pathology (Daniel J. Rowan, Rondell P. Graham)
| | - Rondell P Graham
- Department of Anatomic Pathology (Daniel J. Rowan, Rondell P. Graham)
| | - Michael J Levy
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Ferga C Gleeson
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Amrit K Kamboj
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Kristin C Mara
- Department of Biomedical Statistics and Informatics (Kristin C. Mara), Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu-Dayyeh
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
| | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology (Ariosto H. Hernandez-Lara, Ana Garcia Garcia de Paredes, Louis M. Wong Kee Song, Michael J. Levy, Ferga C. Gleeson, Amrit K. Kamboj, Barham K. Abu-Dayyeh, Vinay Chandrasekhara, Prasad G. Iyer, Andrew C. Storm, Elizabeth Rajan)
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Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound. J Clin Med 2021; 10:jcm10051076. [PMID: 33807558 PMCID: PMC7961381 DOI: 10.3390/jcm10051076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis.
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Zhang Q, Tan Q, Liu J, Chen W, Huang J, Lei S, Li Y, Long X, Wang C, Xiao Y, Wu D, Zheng H, Ma T. 1.5-Dimensional Circular Array Transducer for In Vivo Endoscopic Ultrasonography. IEEE Trans Biomed Eng 2021; 68:2930-2939. [PMID: 33531295 DOI: 10.1109/tbme.2021.3056140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Traditional endoscopic ultrasonography (EUS), which uses one-dimensional (1-D) curvilinear or radial/circular transducers, cannot achieve dynamic elevational focusing, and the slice thickness is not sufficient. The purpose of this study was to design and fabricate a 1.5-dimensional (1.5-D) circular array transducer to achieve dynamic elevational focusing in EUS in vivo. METHODS An 84 × 5 element 1.5-D circular array transducer was successfully developed and characterized in this study. It was fabricated with PZT-5H 1-3 composite that attained a high-electromechanical coupling factor and low-acoustic impedance. The acoustic field distribution was measured with different transmission modes to validate the 1.5-D elevational beam focusing capability. The imaging performance of the 84 × 5 element 1.5-D circular array transducer was evaluated by two wire phantoms, an agar-based cyst phantom, an ex vivo swine pancreas, and an in vivo rhesus macaque rectum based on multifocal ray-line imaging method with five-row elevational beam steering. RESULTS It was demonstrated that the transducer exhibited a central frequency of 6.47 MHz with an average bandwidth of 50%, a two-way insertion loss of 23 dB, and crosstalk of <-26 dB around the center frequency. CONCLUSION Dynamic elevational focusing and the enhancement of the slice thickness in EUS were obtained with a 1.5-D circular array transducer. SIGNIFICANCE This study promotes the development of multirow and two-dimensional array EUS probes for a more precise clinical diagnosis and treatment.
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Gastric carcinoma with lymphoid stroma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:471-477. [PMID: 33386563 DOI: 10.1007/s12328-020-01300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
A 78-year-old man with a subepithelial lesion (SEL) in the gastric body and two carcinomas in the gastric antrum was referred to our hospital. Following a diagnosis of SEL, the patient was followed-up by esophagogastroduodenoscopy annually for 4 years. Although the SEL had increased in size over the years, histological evaluation of the forceps biopsies did not reveal any significant findings. We detected a hypoechoic mass in the submucosa by endoscopic ultrasonography, and suspected the lesion to be an aberrant pancreas or mesenchymal tumor. The patient first underwent endoscopic submucosal dissection for the 2 gastric cancers. Histological examination of the resected specimens revealed intramucosal well-differentiated tubular adenocarcinomas. Next, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed for the gastric SEL. Aspirated specimens revealed an adenocarcinoma with lymphocyte infiltration. The lesion was diagnosed as a gastric carcinoma with lymphoid stroma (GCLS). Subsequently, he underwent distal gastrectomy, and the surgical specimen was confirmed as GCLS corresponding to preoperative diagnosis. In addition, the adenocarcinoma cells were positive for Epstein-Barr (EB) virus-encoded small RNA-1 by in situ hybridization. Finally, the lesion was diagnosed as GCLS associated with EB virus. Thus, EUS-FNA is advantageous for diagnosing GCLS associated with EB virus.
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Seifert H, Fusaroli P, Arcidiacono PG, Braden B, Herth F, Hocke M, Larghi A, Napoleon B, Rimbas M, Ungureanu BS, Sãftoiu A, Sahai AV, Dietrich CF. Controversies in EUS: Do we need miniprobes? Endosc Ultrasound 2021; 10:246-269. [PMID: 34380805 PMCID: PMC8411553 DOI: 10.4103/eus-d-20-00252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the fifth in a series of papers entitled "Controversies in EUS." In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
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Affiliation(s)
- Hans Seifert
- Department of Gastroenterology, Evangelisches Krankenhaus, Oldenburg; Universitatsklinik fur Innere Medizin - Gastroneterologie, Hepatologie; Klinikum Oldenburg, Germany
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Paolo Giorgio Arcidiacono
- Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I, John Radcliffe Hospital I, Oxford, OX3 9DU, UK
| | - Felix Herth
- 2nd Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
| | - Michael Hocke
- Department of Medicine, Helios Klinikum Meiningen, Meiningen, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Bertrand Napoleon
- 2nd Digestive Endoscopy Unit, HopitalPrivé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest; Department of Internal Medicine, Carol Davila University of Medicine Bucharest, Romania
| | - Bogdan Silvio Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Sãftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Sato D, Takamatsu T, Umezawa M, Kitagawa Y, Maeda K, Hosokawa N, Okubo K, Kamimura M, Kadota T, Akimoto T, Kinoshita T, Yano T, Kuwata T, Ikematsu H, Takemura H, Yokota H, Soga K. Distinction of surgically resected gastrointestinal stromal tumor by near-infrared hyperspectral imaging. Sci Rep 2020; 10:21852. [PMID: 33318595 PMCID: PMC7736345 DOI: 10.1038/s41598-020-79021-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022] Open
Abstract
The diagnosis of gastrointestinal stromal tumor (GIST) using conventional endoscopy is difficult because submucosal tumor (SMT) lesions like GIST are covered by a mucosal layer. Near-infrared hyperspectral imaging (NIR-HSI) can obtain optical information from deep inside tissues. However, far less progress has been made in the development of techniques for distinguishing deep lesions like GIST. This study aimed to investigate whether NIR-HSI is suitable for distinguishing deep SMT lesions. In this study, 12 gastric GIST lesions were surgically resected and imaged with an NIR hyperspectral camera from the aspect of the mucosal surface. Thus, the images were obtained ex-vivo. The site of the GIST was defined by a pathologist using the NIR image to prepare training data for normal and GIST regions. A machine learning algorithm, support vector machine, was then used to predict normal and GIST regions. Results were displayed using color-coded regions. Although 7 specimens had a mucosal layer (thickness 0.4-2.5 mm) covering the GIST lesion, NIR-HSI analysis by machine learning showed normal and GIST regions as color-coded areas. The specificity, sensitivity, and accuracy of the results were 73.0%, 91.3%, and 86.1%, respectively. The study suggests that NIR-HSI analysis may potentially help distinguish deep lesions.
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Affiliation(s)
- Daiki Sato
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Toshihiro Takamatsu
- Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
- Research Institute for Biomedical Sciences, Tokyo University of Science, Noda, Chiba, Japan.
| | - Masakazu Umezawa
- Department of Materials Science and Technology, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
| | - Yuichi Kitagawa
- Department of Materials Science and Technology, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
| | - Kosuke Maeda
- Department of Mechanical Engineering, Tokyo University of Science, Noda, Chiba, Japan
| | - Naoki Hosokawa
- Department of Materials Science and Technology, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
| | - Kyohei Okubo
- Department of Materials Science and Technology, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
- Imaging Frontier Center, Tokyo University of Science, Noda, Chiba, Japan
| | - Masao Kamimura
- Department of Materials Science and Technology, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
- Imaging Frontier Center, Tokyo University of Science, Noda, Chiba, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tetsuo Akimoto
- Division of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeshi Kuwata
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Hiroshi Takemura
- Research Institute for Biomedical Sciences, Tokyo University of Science, Noda, Chiba, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Noda, Chiba, Japan
| | - Hideo Yokota
- RIKEN Center for Advanced Photonics, Wako, Saitama, Japan
| | - Kohei Soga
- Research Institute for Biomedical Sciences, Tokyo University of Science, Noda, Chiba, Japan
- Department of Materials Science and Technology, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
- Imaging Frontier Center, Tokyo University of Science, Noda, Chiba, Japan
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Efficacy of endoscopic ultrasound with artificial intelligence for the diagnosis of gastrointestinal stromal tumors. J Gastroenterol 2020; 55:1119-1126. [PMID: 32918102 DOI: 10.1007/s00535-020-01725-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although endoscopic ultrasound (EUS) is reported to be suitable for determining the layer from which subepithelial lesions (SELs) originate, it is difficult to distinguish gastrointestinal stromal tumor (GIST) from non-GIST using only EUS images. If artificial intelligence (AI) can be used for the diagnosis of SELs, it should provide several benefits, including objectivity, simplicity, and quickness. In this pilot study, we propose an AI diagnostic system for SELs and evaluate its efficacy. METHODS Thirty sets each of EUS images with SELs ≥ 20 mm or < 20 mm were prepared for diagnosis by an EUS diagnostic system with AI (EUS-AI) and three EUS experts. The EUS-AI and EUS experts diagnosed the SELs using solely the EUS images. The concordance rates of the EUS-AI and EUS experts' diagnoses were compared with the pathological findings of the SELs. RESULTS The accuracy, sensitivity, and specificity for SELs < 20 mm were 86.3, 86.3, and 62.5%, respectively for the EUS-AI, and 73.3, 68.2, and 87.5%, respectively, for the EUS experts. In contrast, accuracy, sensitivity, and specificity for SELs ≥ 20 mm were 90.0, 91.7, and 83.3%, respectively, for the EUS-AI, and 53.3, 50.0, and 83.3%, respectively, for the EUS experts. The area under the curve for the diagnostic yield of the EUS-AI for SELs ≥ 20 mm (0.965) was significantly higher than that (0.684) of the EUS experts (P = 0.007). CONCLUSION EUS-AI had a good diagnostic yield for SELs ≥ 20 mm. EUS-AI has potential as a good option for the diagnosis of SELs.
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Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to provide an in-depth review of gastric subepithelial lesions (SELs) and describe the current approach to endoscopic diagnosis and management of these lesions. RECENT FINDINGS Gastric SELs are a relatively frequent finding on routine endoscopy (incidence 0.2-3%). A systematic approach to diagnosis and management is key because many SELs are of little consequence, while others carry a high risk of malignant transformation. Because esophagogastroduodenoscopy (EGD) cannot delineate depth of invasion or subepithelial appearance, endoscopic ultrasound (EUS) should be considered a first-line modality. Recent data suggest EUS-guided fine needle biopsy (FNB) may be superior to traditional fine needle aspiration (FNA) for the diagnosis of gastric SELs due to its ability to obtain histologic specimens for immunohistochemical staining. Alternative techniques for tissue sampling (combined with simultaneous resection) include submucosal resection, endoscopic submucosal dissection (ESD), submucosal tunnelling with endoscopic resection (STER) or endoscopic full-thickness resection (EFTR). SUMMARY This review details the endoscopic diagnosis and management of gastric SELs. Although EUS-guided sampling remains a first-line strategy (preferably with FNB), recent techniques including ESD, STER and EFTR have the potential to provide additional diagnostic and therapeutic options.
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Xu J, Zhou J, Wang X, Fan S, Huang X, Xie X, Yu R. A multi-class scoring system based on CT features for preoperative prediction in gastric gastrointestinal stromal tumors. Am J Cancer Res 2020; 10:3867-3881. [PMID: 33294273 PMCID: PMC7716157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023] Open
Abstract
Our study aimed to establish and validate a multi-class scoring system for preoperative gastric gastrointestinal stromal tumors (GISTs) risk stratifications based on CT features. 150 gastric GIST patients who underwent contrast-enhanced CT examination and surgical resection from hospital 1 were retrospectively analyzed as the training cohort, and 61 patients from hospitals 2 and 3 were included as the validation cohort. A model was established by logistic regression analysis and weighted to be a scoring model. A calibration test, area under the receiver operating characteristic (ROC) curve (AUC), and cutoff points were determined for the score model. The model was also divided into three score ranges for convenient clinical evaluation. Five CT features were included in the score model, including tumor size (4 points), ill-defined margin (6 points), intratumoral enlarged vessels (5 points), heterogeneous enhancement pattern (4 points), and exophytic or mixed growth pattern (2 points). Then, based on the calibration results, performance was merely assessed as very low and high* risk. The AUCs of the score model for very low risk and high* risk were 0.973 and 0.977, and the cutoff points were 3 points (97.30%, 93.81%) and 7 points (92.19%, 94.19%), respectively. In the validation cohort, the AUCs were 0.912 and 0.972, and the cutoff values were 3 points (92.31%, 85.42%) and 5 points (100%, 87.88%), respectively. The model was stratified into 3 ranges: 0-3 points for very low risk, 4-8 points for low risk, and 9-21 points for high* risk. A concise and practical score system for gastric GISTs risk stratification was proposed.
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Affiliation(s)
- Jianxia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University318 Chaowang Road, Hangzhou 310005, Zhejiang Province, China
| | - Jiaping Zhou
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China
| | - Xiaojie Wang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China
| | - Shufeng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University318 Chaowang Road, Hangzhou 310005, Zhejiang Province, China
| | - Xiaoshan Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University318 Chaowang Road, Hangzhou 310005, Zhejiang Province, China
| | - Xingwu Xie
- Department of Radiology, Renmin Hospital, Hubei University of MedicineShiyan 442000, Hubei Province, China
| | - Risheng Yu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China
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