title: EUS-guided single-incision needle-knife biopsy: description and results of a new method for tissue sampling of subepithelial GI tumors (with video).
abstract: BACKGROUND
  The diagnostic efficacy of current tissue sampling techniques for upper GI subepithelial tumors (SETs) appears to be limited. Better tissue acquisition techniques are needed to improve the diagnostic yield in this setting.
  
  
  OBJECTIVE
  Our purpose was to determine the safety and diagnostic yield of EUS-guided needle-knife incision and forceps biopsy (SINK biopsy) of upper GI SETs.
  
  
  METHODS
  Retrospective database review.
  
  
  METHODS
  Academic tertiary-care referral center.
  
  
  METHODS
  This study involved 14 consecutive patients referred for EUS evaluation of upper GI SETs with previous unsuccessful attempts at tissue diagnosis by conventional forceps biopsy.
  
  
  METHODS
  EUS-guided needle-knife incision and forceps biopsy.
  
  
  METHODS
  The safety and diagnostic yield of this method, compared with EUS-guided fine-needle aspiration (EUS-FNA), when possible.
  
  
  RESULTS
  SINK biopsy provided tissue samples that were sufficient for definite histologic diagnosis in 13 of 14 cases (diagnostic yield 92.8%). There were 8 gastric GI stromal tumors. In 7 of 8, the size of SINK specimens allowed immunohistochemical analysis, and the evaluation of malignant potential was carried out by means of mitotic index determination in 5 cases (71.42%). SINK biopsies determined the pathological diagnosis of all (4 of 4) nonmesenchymal lesions. Eight patients underwent both EUS-FNA and SINK, with final histologic diagnosis determined in 6 of 8 cases (75%) by SINK versus 1 of 8 cases (12.5%) by EUS-FNA (Fisher exact test, P = .023). There were no procedure-related complications.
  
  
  CONCLUSIONS
  A single-center, retrospective analysis with small sample size.
  
  
  CONCLUSIONS
  SINK biopsy appears to be an easy, safe, and effective technique for determining the definitive pathological diagnosis, evaluation of the malignant potential, and planning management of SETs. It could be a reliable alternative to conventional FNA, providing larger samples that improve the histologic yield.
authors.affiliation: Division of Digestive Endoscopy, Department of Gastroenterology, Río Hortega Hospital, Valladolid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: de la Serna-Higuera
authors.forename: Manuel
authors.initials: M
authors.lastname: Pérez-Miranda
authors.forename: Pilar
authors.initials: P
authors.lastname: Díez-Redondo
authors.forename: Paula
authors.initials: P
authors.lastname: Gil-Simón
authors.forename: Teresa
authors.initials: T
authors.lastname: Herranz
authors.forename: Elena
authors.initials: E
authors.lastname: Pérez-Martín
authors.forename: C
authors.initials: C
authors.lastname: Ochoa
authors.forename: Agustín
authors.initials: A
authors.lastname: Caro-Patón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002828:Choristoma / Q000473:pathology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007889:Leiomyoma / Q000473:pathology; D008067:Lipoma / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D010179:Pancreas; D011127:Polyps / Q000473:pathology; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000473:pathology*; D018084:Ultrasonography, Interventional