Background and study aims This study was designed to evaluate the impact of additional tissue obtained with endoscopic ultrasound (EUS)-guided 25-gauge core biopsy needle (25G-PC) following an unsuccessful fine-needle biopsy (FNB) performed with larger-bore needles for the characterization of gastrointestinal subepithelial lesions (GI-SELs).
Patients and methods We prospectively collected and retrospectively analyzed information in our database from January 2013 to June 2017 for all patients with GI-SELs who received a EUS-guided FNB (EUS-FNB) with 25G-PC during the same procedure after failure of biopsy performed with larger-bore needle. Diagnostic yield, diagnostic accuracy and procedural complications were evaluated.
Results Sixteen patients were included in this study, 10 men and 6 women, median age 67.8 (range 43 to 76 years). Five patients were found to have a SEL localized in the distal duodenum, five in the gastric antrum, two in the gastric fundus and four in the gastric body. The mean size of the lesions was 20.5 mm (range 18 – 24 mm). EUS-FNB with 25G-PC enabled final diagnosis in nine patients (56.2 %). Regarding the subgroup of duodenal lesions, the procedure was successful in four of five (80 %). Final diagnoses with EUS-guided sampling were GIST (n = 6), leiomyoma (n = 2) and metastatic ovarian carcinoma (n = 1). No procedure-related complications were recorded.
Conclusion In patients with small GI-SELs, additional tissue obtained with 25G-PC could represents a “rescue” strategy after an unsuccessful procedure with larger-bore needles, especially when lesions are localized in the distal duodenum.
References
1
Landi B,
Palazzo L.
The role of endosonography in submucosal tumours. Best Pract Res Clin Gastroenterol 2009; 23: 679-701
2
Papanikolaou IS,
Triantafyllou K,
Kourikou A.
et al. Endoscopic ultrasonography for gastric submucosal lesions. World J Gastrointest Endosc 2011; 3: 86-94
3
Ponsaing LG,
Kiss K,
Loft A.
et al. Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007; 13: 3301-3310
4
Binmoeller KF,
Thul R,
Rathod V.
et al. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc 1998; 47: 335-340
6
Levy MJ,
Jondal ML,
Clain J.
et al. Preliminary experience with an EUS-guided trucut biopsy needle compared with EUS-guided FNA. Gastrointest Endosc 2003; 57: 101-106
7
Antonini F,
Delconte G,
Fuccio L.
et al. Endoscopic ultrasound-guided tissue sampling with a 20-gauge core biopsy needle for the characterization of gastrointestinal subepithelial lesions: a multicenter study. Endosc Ultrasound 2018;
8
Iglesias-Garcia J,
Poley JW,
Larghi A.
et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
9
Larghi A,
Iglesias-Garcia J,
Poley JW.
et al. Feasibility and yield of a novel 22-gauge histology EUS needle in patients with pancreatic masses: a multicenter prospective cohort study. Surg Endosc 2013; 27: 3733-3738
10
Fabbri C,
Luigiano C,
Maimone A.
et al. Endoscopic ultrasound-guided fine-needle biopsy of small solid pancreatic lesions using a 22-gauge needle with side fenestration. Surg Endosc 2015; 29: 1586-1590
11
Antonini F,
Fuccio L,
Giorgini S.
et al. Biliary plastic stent does not influence the accuracy of endoscopic ultrasound-guided sampling of pancreatic head masses performed with core biopsy needles. Dig Liver Dis 2017; 49: 898-902
12
Attam R,
Arain MA,
Bloechl SJ.
et al. “Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc 2015; 81: 1401-1407
15
Mekky MA,
Yamao K,
Sawaki A.
et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 2010; 71: 913-919
16
Suzuki T,
Arai M,
Matsumura T.
et al. Factors associated with inadequate tissue yield in EUS-FNA for gastric SMT. ISRN Gastroenterol 2011; 2011: 619128
17
Akahoshi K,
Sumida Y,
Matsui N.
et al. Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 2007; 13: 2077-2082
18
Akahoshi K,
Oya M,
Koga T.
et al. Clinical usefulness of endoscopic ultrasound-guided fine needle aspiration for gastric subepithelial lesions smaller than 2 cm. J Gastrointestin Liver Dis 2014; 23: 405-412
20
Kim GH,
Cho YK,
Kim EY.
Korean EUS Study Group.
et al. Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand J Gastroenterol 2014; 49: 347-354
21
Lee M,
Min BH,
Lee H.
et al. Feasibility and diagnostic yield of endoscopic ultrasonography-guided fine needle biopsy with a new core biopsy needle device in patients with gastric subepithelial tumors. Medicine (Baltimore) 2015; 94: e1622
22
Lee JH,
Cho CJ,
Park YS.
et al. EUS-guided 22-gauge fine needle biopsy for the diagnosis of gastric subepithelial tumors larger than 2 cm. Scand J Gastroenterol 2016; 51: 486-493
25
Yegin EG,
Duman DG.
Small EUS-suspected gastrointestinal stromal tumors of the stomach: An overview for the current state of management. Endosc Ultrasound 2016; 5: 69-77
27
ESMO/European Sarcoma Network Working Group.
Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 (Suppl. 03) iii21-iii6
28
Iwashita T,
Nakai Y,
Samarasena JB.
et al. High single-pass diagnostic yield of a new 25-gauge core biopsy needle for EUS-guided FNA biopsy in solid pancreatic lesions. Gastrointest Endosc 2013; 77: 909-915
30
Koizumi S,
Kida M,
Yamauchi H.
et al. Clinical implications of doubling time of gastrointestinal submucosal tumors. World J Gastroenterol 2016; 22: 10015-10023
