Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors

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• 作者：Mohamed A. Mekky ; Kenji Yamao ; Akira Sawaki ; Nobumasa Mizuno ; Kazuo Hara ; Mohamed A. Nafeh ; Ashraf M. Osman ; Takashi Koshikawa ; Yasushi Yatabe ; Vikram Bhatia
• 刊名：Gastrointestinal Endoscopy
• 出版年：2010
• 出版时间：May 2010
• 年：2010
• 卷：71
• 期：6
• 页码：913-919
• 全文大小：720 K

文摘

Background

Submucosal tumors (SMTs) comprise both benign and malignant lesions, and most of the gastric lesions tend to be malignant. The addition of EUS-guided FNA (EUS-FNA) has the potential to improve this distinction, but published series are limited.

Objective

To evaluate the yield of EUS-FNA in gastric SMTs with referral to a criterion standard final diagnosis.

Design

Retrospective study.

Setting

Tertiary-care referral center.

Patients

This study involved 141 consecutive patients with gastric SMTs, who underwent EUS-FNA from January 2000 to December 2008. Immunohistochemical staining with c-kit, CD34, actin, and S-100 antibodies was done if a spindle cell tumor was found. Based on FNA sample adequacy, and whether a specific diagnosis could be established, EUS-FNA results were categorized as diagnostic, suggestive, or nondiagnostic. The criterion standards for final diagnosis were the surgical histopathological results or the follow-up course for malignant, inoperable cases.

Intervention

EUS-FNA.

Main Outcome Measurements

Diagnostic yield of EUS-FNA and factors related to sampling adequacy for cytological and immunohistochemical evaluation.

Results

A total of 141 patients (52 % female, mean age 56.7 years) underwent EUS-FNA (range 1-5 passes). The overall results of EUS-FNA were diagnostic, suggestive, and nondiagnostic in 43.3 % , 39 % , and 17.7 % of cases, respectively. Adequate specimens were obtained in 83 % of cases, and 69 cases (48.9 % ) had a definitive final diagnosis. The most common gastric SMT was GI stromal tumor (59.5 % ). EUS-FNA results were 95.6 % accurate (95 % confidence interval [CI], 87.5 % -99 % ) for the final diagnosis and 94.2 % (95 % CI, 85.6 % -98.1 % ) accurate for differentiating potentially malignant lesions. A heterogeneous echo pattern was the only independent predictor for sampling adequacy (adjusted odds ratio 6.15; P = .002). There were no procedure-related complications.

Limitations

Possibility of selection bias.

Conclusion

EUS-FNA is an accurate method for diagnosis of gastric SMTs and for differentiating malignant lesions.