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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 10, 2015; 7(14): 1142-1149
Published online Oct 10, 2015. doi: 10.4253/wjge.v7.i14.1142
Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy
Hisatomo Ikehara, Zhaoliang Li, Jiro Watari, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Toshihiko Tomita, Tadayuki Oshima, Hirokazu Fukui, Ikuo Matsuda, Seiichi Hirota, Hiroto Miwa
Hisatomo Ikehara, Zhaoliang Li, Jiro Watari, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Toshihiko Tomita, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Ikuo Matsuda, Seiichi Hirota, Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Author contributions: Ikehara H and Li Z contributed equally to this work; Watari J and Miwa H designed and performed the research study; Ikehara H, Li Z, Taki M, Kondo T, Tozawa K performed the procedures; All the authors helped to collect the data; Matsuda I and Hirota S diagnosed the histology; Watari J performed statistical analysis and wrote the paper.
Institutional review board statement: This study was approved by the Institutional Review Board at Hyogo College of Medicine, Nishinomiya, Japan.
Informed consent statement: All patients in the study gave informed consent for the procedures.
Conflict-of-interest statement: None.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author (watarij@hyo-med.ac.jp). Consent for data sharing was not obtained from the participants, but the presented data are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jiro Watari, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
watarij@hyo-med.ac.jp
Telephone: +81-798-456662 Fax: +81-798-456661
Received: April 19, 2015
Peer-review started: April 21, 2015
First decision: June 3, 2015
Revised: June 21, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: October 10, 2015
Processing time: 182 Days and 21.8 Hours
AIM: To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) without cytology and mucosal cutting biopsy (MCB) in the histological diagnosis of gastric submucosal tumor (SMT).
METHODS: We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥ 1 cm in diameter. who underwent both EUS-FNAB and MCB were investigated.
RESULTS: The histological diagnoses were gastrointestinal stromal tumors (n = 7), leiomyoma (n = 6), schwannoma (n = 2), aberrant pancreas (n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors’ mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method (P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUS-FNAB (P = 0.03). No complications were found in either method.
CONCLUSION: MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUS-FNAB should be performed for SMTs with extraluminal growth.
Core tip: We prospectively compared the diagnostic yield and the safety between endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) without cytology and mucosal cutting biopsy (MCB) based on endoscopic submucosal dissection. Although no significant difference in histological diagnosis was found between EUS-FNAB and MCB, diagnostic specimens were significantly more frequently obtained in the lesions with intraluminal growth compared to those with extraluminal growth by the MCB method. All submucosal tumors (SMTs) with extraluminal growth were diagnosed only by EUS-FNAB. No complications were found in either method. Therefore, MCB may be chosen as an alternative diagnostic modality in tumors showing intraluminal growth, whereas EUS-FNAB should be performed for SMTs with extraluminal growth.
