title: EUS-guided 22-gauge fine needle biopsy for the diagnosis of gastric subepithelial tumors larger than 2 cm.
abstract: EUS-guided fine needle biopsy (EUS-FNB) was introduced to obtain tissue cores. However, data on the efficacy of EUS-FNB for the diagnosis of gastric subepithelial tumors (SET) are limited. This study was aimed to determine the tissue acquisition and diagnostic yield of EUS-FNB using a novel 22-gauge FNB needle.
  
  
  
  Between May 2012 and February 2014, we retrieved data on 78 consecutive patients who underwent 22-gauge EUS-FNB for tissue sampling of gastric SET larger than 2 cm. Relevant tumor and EUS-related parameters were reviewed retrospectively.
  
  
  
  The median tumor diameter was 2.8 cm and tumors were punctured successfully in 77 SET (98.7%). EUS-FNB was diagnostic in 81.8% of SET (63/77), by obtaining core biopsy tissue in 96.8% (61/63) and aspirates in 27.0% (17/63). FNB specimens permitted immunostaining for the diagnosis of gastrointestinal stromal tumors (GIST) in 30 SET (47.6%), 20 leiomyomas (31.7%), and 3 schwannomas (4.8%). Diagnoses could be made without immunostaining in 10 SET (15.9%). Tissue adequacy was optimal in 85.7% of FNB specimens by endosonographers' on-site visual evaluation. Endosonographers' evaluation of tissue adequacy was the only factor significantly associated with a higher diagnostic yield in univariate analysis. No adequate high-power fields for GIST risk stratification were available in FNB specimens. There was a single case of post-procedural bleeding (1.3%).
  
  
  
  EUS-FNB using 22-gauge needle obtains a high yield for the diagnosis of gastric SET ≥2 cm, mostly via core tissue acquisition. Endosonographers should pay careful attention to the adequacy of FNB specimens.
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Cho
authors.affiliation: b 2 Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Hee Kyong
authors.initials: HK
authors.lastname: Na
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.affiliation: a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea.
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D019160:Endosonography; D004848:Epithelium / Q000473:pathology; D004867:Equipment Design; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: endosonography; fine-needle biopsy; stomach; subepithelial tumors