EUS-guided sampling of suspected GI stromal tumors.
BACKGROUND
The diagnostic yield of EUS-guided FNA (EUS-FNA) of suspected GI stromal tumors (GIST) has not been assessed in large series.


OBJECTIVE
Our purpose was to determine the diagnostic yield of EUS-FNA of subepithelial lesions with EUS features suggestive of GIST.


METHODS
Retrospective database review.


METHODS
Tertiary care referral center and an urban Veterans Administration hospital.


METHODS
Consecutive patients referred for EUS evaluation of upper GI subepithelial lesions of the fourth endosonographic layer who underwent EUS-FNA.


METHODS
Proportion of patients whose cytopathologic examination was diagnostic (immunohistochemical stains establish a specific diagnosis), suspicious (spindle cells identified, quantity not sufficient for specific stains), or nondiagnostic.


RESULTS
A total of 112 patients (45.5% female, mean age 61.6 years) underwent EUS-FNA (mean number of FNA passes 5.3). Tumor location was as follows: stomach 62.5%, esophagus 30.4%, and duodenum 7.1%. EUS-FNA was diagnostic in 61.6%, suspicious (spindle cells) in 22.3%, and nondiagnostic in 16.1%. The histologic results were 31.3% GIST, 26.8% leiomyomas, 22.3% spindle cell neoplasms, 3.5 % neural tumors, and 16.1% nondiagnostic. Fifteen (12.5%) patients also underwent EUS-guided core needle biopsy needle sampling; 7 were diagnostic, 2 suspicious, and 6 nondiagnostic. Twenty-four (20.0%) patients underwent jumbo forceps sampling; 5 were diagnostic, 1 suspicious, and 18 nondiagnostic. There were no cases of diagnostic core needle biopsy after nondiagnostic FNA core needle biopsy. Jumbo forceps biopsy of ulcerated masses was diagnostic in 3 GISTs in which FNA was nondiagnostic. Univariate and multivariate analyses showed that no variable was associated with an increased diagnostic yield.


CONCLUSIONS
EUS-FNA sampling of subepithelial lesions was diagnostic in 61.6% and showed a spindle cell neoplasm ("suspicious") in another 22.3% (diagnostic yield 83.9%). Core needle biopsy needle sampling did not increase the yield, but in the setting of an ulcerated mass, forceps biopsy may be diagnostic.
Hoda
Katherine M
KM
Department of Gastroenterology/Hepatology, Oregon Health and Science University, Portland, Oregon 97239, USA.
Rodriguez
Sarah A
SA
Faigel
Douglas O
DO
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D041742:Upper Gastrointestinal Tract / Q000473:pathology*