title: Clinical usefulness of endoscopic ultrasound-guided fine needle aspiration for gastric subepithelial lesions smaller than 2 cm.
abstract: OBJECTIVE
  There is no evidence of postoperative metastasis of gastric gastrointestinal stromal tumors (GISTs) smaller than 2 cm. The aim of this study was to evaluate the clinical usefulness of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) for gastric subepithelial lesions (SELs) smaller than 2 cm.
  
  
  METHODS
  Using a prospectively maintained EUS-FNA database, 90 consecutive EUS-FNAs of gastric hypoechoic solid SELs smaller than 2 cm diagnosed by EUS were evaluated retrospectively. The reference standards for the final diagnosis were surgery (n=44) and/or clinical follow-up (n=46) using esophagogastroduodenoscopy (EGD), CT, and/or ultrasonography (US). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.
  
  
  RESULTS
  The diagnostic rate of EUS-FNA for gastric hypoechoic solid SELs smaller than 2 cm was 73% (66/90). Histological diagnosis of EUS-FNA showed 47 (52%) malignant SELs (44 GISTs, 1 glomus tumor, 1 SEL like cancer, and 1 malignant lymphoma), 19 (21%) benign SELs (14 leiomyomas, 4 ectopic pancreas, and 1 neurinoma), and 24 (27%) indeterminate SELs. In 44 surgically resected cases, the diagnostic accuracy of EUS-FNA using immunohistochemical analysis was 98% (43/44). There were no complications. Appropriate management was performed in 65 out of 66 SELs (98%) diagnosed by definitive EUS-FNA. After surgery, there was no recurrence of malignant SELs.
  
  
  CONCLUSIONS
  EUS-FNA is an accurate and safe method in the pre-therapeutic diagnosis of gastric SELs smaller than 2 cm. EUS-FNA for gastric SELs smaller than 2 cm is a promising way to permit early management of patients with gastric SELs including GIST.
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan. kakahoshi2@aol.com.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Akahoshi
authors.affiliation: Department of Pathology, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oya
authors.affiliation: Department of Surgery, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Koga
authors.affiliation: Division of Central Laboratory, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Motomura
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubokawa
authors.affiliation: Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan.
authors.forename: Jyuya
authors.initials: J
authors.lastname: Gibo
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor