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Clinical Trial
. 2007 Apr 14;13(14):2077-82.
doi: 10.3748/wjg.v13.i14.2077.

Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration

Kazuya Akahoshi  1 , Yorinobu Sumida, Noriaki Matsui, Masafumi Oya, Rie Akinaga, Masaru Kubokawa, Yasuaki Motomura, Kuniomi Honda, Masayuki Watanabe, Takashi Nagaie
Affiliations
Clinical Trial

Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration

Kazuya Akahoshi et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in the preoperative diagnosis of gastrointestinal stromal tumor (GIST).

Methods: From September 2002 to June 2006, Fifty-three consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 31), or clinical follow-up (n=22). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.

Results: In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% (42/51). The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% (15/21), 86% (18/21), and 100% (9/9), respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100% (24/24), 80% (4/5), 96% (24/25), 100% (4/4), and 97% (28/29), respectively. No major complications were encountered.

Conclusion: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.

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Figures

Figure 1
Figure 1
Toshiba-Fujinon curved linear array echoendoscope PEF-708FA.
Figure 2
Figure 2
Olympus power shot type metallic needle NA-11J-KB.
Figure 3
Figure 3
A: Submucosal lesion in the angulus of the stomach shown on endoscopy; B: EUS using ultrasound catheter probe reveals 3 cm subepithelial hypoechoic tumor with continuity to proper muscle layer (arrow-mp); C: Puncture of the small GIST under direct endosonographic visualization. The needle can be visualized; D: EUS-FNA smear of GIST showing a small tissue fragment composed of ovoid to spindle-shaped nuclei with minimal to no atypia arranged in fascicles (modified Giemsa stain).
Figure 4
Figure 4
Photomicrographs of EUS-FNA specimen of GIST. A: Hematoxylin-eosin stain; B: Immunohistochemical stain for c-kit; C: Immunohistochemical stain for CD34; D: Immunohistochemical stain muscle actin; E: Immunohistochemical stain for S-100. The tumor is diffusely positive for c-kit and CD34 and negative for muscle actin and S-100. The immunohistochemical pattern diagnosis is GIST.
Figure 5
Figure 5
A: Endoscopy showing submucosal lesion in the upper body of the stomach; B: EUS using ultrasound catheter probe demonstrating 1.5 cm subepithelial hypoechoic tumor with continuity to proper muscle layer (arrow-mp); C: The hypoechoic mass shown on EUS was punctured under real-time EUS guidance; D: The FNAB specimen consisted of acinar cells. The histologic diagnosis was ectopic pancreas.
Figure 6
Figure 6
EUS-FNA diagnosis and following management.
Figure 7
Figure 7
Algorithm of diagnosis and treatment of gastrointestinal submucosal tumor.
See this image and copyright information in PMC

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