The diagnostic yield and accuracy of EUS-FNA for diagnosing gastrointestinal submucosal tumors before surgical operation

Abstract

Study aim : We retrospectively analyzed the diagnostic yield and accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) for diagnosing gastrointestinal submucosal tumors before surgical resection.
Subjects and Methods : A total of 194 patients with SMT in the gastrointestinal tract were underwent EUS-FNA (208 FNAs) from January 2001 to October 2011 in Kitasato University East Hospital. Sixty three patients (69 FNAs) in whom surgical resection was carried out were included in the final analysis. These subjects included one esophagus, the 57 stomachs, the four duodena, and the one large intestine. Histological diagnosis (mean size : 3.5cm；range : 1.3-16.5cm) are 53 GIST, three Schwannoma, two hamartoma, one granular cell tumor, one glomus tumor, one carcinoid, etc. Puncture was performed with 19-gauge needles and 22-gauge needles and 25-gause needles. A negative pressure of air by 10 or 20 cm syringe was applied in all cases. The needle was passed back and forth in the target lesion 10 to 20 times to obtain a tissue sample. The average of times of puncture was 2.7 times (range : 1-5) .
Results : The overall tissue-sampling rate was 91.3% (63/69) : 100% (1/1) in esophagus, 96.6% (58/60) in stomach, 33.3% (2/6) in duodenum, 100% (2/2) in large intestine. The overall diagnostic yield was 84.1% (53/63) : 100% (1/1) in esophagus, 85.9% (49/57) in stomach, 50% (2/4) in duodenum, 100% (1/1) in large intestine. The diagnostic accuracy was 96.2% (51/53) : 95.9% (47/49) in stomach. Of the total of 69 punctures, 50 (72.5%) had adequate FNA materials for immunohistochemical analysis. That diagnostic accuracy was 97.9% (48/49) : 97.7% (44/45) in stomach.
Conclusions : In our study, comparatively high diagnostic accuracy was obtained and EUS-FNA for gastrointestinal SMT was considered to be the useful diagnosis modality.