Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(08): E695-E705
DOI: 10.1055/s-0043-112497
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Comparison of submucosal tunneling biopsy versus EUS-guided FNA for gastric subepithelial lesions: a prospective study with crossover design

Hideki Kobara
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Hirohito Mori
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Naoki Nishimoto
2   Department of Clinical Research Support Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Shintaro Fujihara
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Noriko Nishiyama
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Maki Ayaki
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Tatsuo Yachida
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Tae Matsunaga
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Taiga Chiyo
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Nobuya Kobayashi
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Koji Fujita
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Kiyohito Kato
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Hideki Kamada
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Makoto Oryu
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Kunihiko Tsutsui
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Hisakazu Iwama
3   Life Science Research Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Reiji Haba
4   Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Tsutomu Masaki
1   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
› Author Affiliations
Further Information

Publication History

submitted 12 December 2016

accepted after revision 22 May 2017

Publication Date:
03 August 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims Endoscopic ultrasound-guided fine needle aspiration (FNA) for gastrointestinal subepithelial lesions (SELs) has limited diagnostic accuracy due to technical problems and small lesion size. We previously reported a novel submucosal tunneling biopsy (STB) technique for sampling SELs. This study aimed to evaluate the diagnostic ability and safety of STB compared to that of FNA for SELs.

Patients and methods The study was a non-randomized, prospective comparative study with crossover design in patients with endoluminal gastric SELs. Forty-three patients, including 29 cases with lesions < 2 cm were enrolled. A crossover design with 2 intervention stages (Group A: FNA followed by STB for 23 SELs, Group B: STB followed by FNA for 20 SELs) was implemented. The primary outcome was the diagnostic yield (DY). Secondary outcomes were technical success rate, procedure time, complication rate, and sample quality.

Results The DY of STB was significantly higher than that of FNA (100 % vs. 34.8 %; P < 0.0001) in group A, including 100 % in overall STB. The technical success rate of STB was significantly higher than that of FNA (100 % vs. 56.5 %; P = 0.0006), whereas the median procedure time of STB was significantly longer than that of FNA (37 minutes vs. 18 minutes; P < 0.0001). The median specimen area of STB samples was markedly larger than that of FNA samples (5.54 mm2 vs. 0.69 mm2; P < 0.001). No complications occurred in either method.

Conclusions STB had significantly superior diagnostic ability and a more adequate sample quality than FNA for endoluminal gastric SELs, indicating the suitability of STB for small SELs.

Clinical trial registration: UMIN 000006754

 

  • References

  • 1 Hwang JH, Kimmey MB. The incidental upper gastrointestinal subepithelial mass. Gastroenterology 2004; 126: 301-307
    CrossrefPubMedSearch in Google Scholar
  • 2 Blay J-Y, Bonvalot S, Casali P. et al. Consensus meeting for the management of gastrointestinal stromal tumors Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 2005; 16: 566-578
    CrossrefPubMedSearch in Google Scholar
  • 3 Mori H, Kobara H, Kobayashi M. et al. Establishment of pure NOTES procedure using a conventional flexible endoscope: review of six cases of gastric gastrointestinal stromal tumors. Endoscopy 2011; 43: 631-634
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Demetri GD, Benjamin R, Blanke C. et al. NCCN Task Force report: optimal management of patients with gastrointestinal stromal tumor (GIST)--expansion and update of NCCN clinical practice guidelines. J Natl Compr Canc Netw 2007; 5: S1-S29
    CrossrefPubMedSearch in Google Scholar
  • 5 National Comprehensive Cancer Network. Clinical practice guidelines in oncology for soft tissue sarcoma. Version 2. Fort Washington, PA: National Comprehensive Cancer Network; 2009
    PubMedSearch in Google Scholar
  • 6 ESMO/European Sarcoma Network Working Group. Gastrointestinal stromal tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25: iii21-iii26
    CrossrefPubMedSearch in Google Scholar
  • 7 Nishida T, Hirota S, Yanagisawa A. et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 2008; 13: 416-430
    CrossrefPubMedSearch in Google Scholar
  • 8 Blackstein ME, Blay J-Y, Corless C. et al. Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol 2006; 20: 157-163
    CrossrefPubMedSearch in Google Scholar
  • 9 Tanaka J, Oshima T, Hori K. et al. Small gastrointestinal stromal tumor of the stomach showing rapid growth and early metastasis to the liver. Dig Endosc 2010; 22: 354-356
    CrossrefPubMedSearch in Google Scholar
  • 10 Aso A, Ihara E, Kubo H. et al. Gastric gastrointestinal stromal tumor smaller than 20 mm with liver metastasis. Clin J Gastroenterol 2013; 6: 29-32
    CrossrefPubMedSearch in Google Scholar
  • 11 Boyce GA, Sivak MV, Rösch T. et al. Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound. Gastrointest Endosc 1991; 37: 449-454
    CrossrefPubMedSearch in Google Scholar
  • 12 Sepe PS, Moparty B, Pitman MB. et al. EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc 2009; 70: 254-261
    CrossrefPubMedSearch in Google Scholar
  • 13 Hoda KM, Rodriguez SA, Faigel DO. EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc 2009; 69: 1218-1223
    CrossrefPubMedSearch in Google Scholar
  • 14 Mohamed A, Yamao K, Sawaki A. et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 2010; 71: 913-919
    CrossrefPubMedSearch in Google Scholar
  • 15 Fernández-Esparrach G, Sendino O, Solé M. et al. Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy 2010; 42: 292-299
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Sumiyama K, Gostout CJ, Rajan E. et al. Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc 2007; 65: 688-694
    CrossrefPubMedSearch in Google Scholar
  • 17 Kobara H, Mori H, Fujiwara S. et al. Bloc biopsy by tunneling method using endoscopic submucosal dissection for an upper gastrointestinal submucosal tumor. Endoscopy 2012; 44: E197-E198
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Kobara H, Mori H, Fujihara S. et al. Bloc biopsy by using submucosal endoscopy with a mucosal flap method for gastric subepithelial tumor tissue sampling (with video). Gastrointest Endosc 2013; 77: 141-145
    CrossrefPubMedSearch in Google Scholar
  • 19 Matsuzaki I, Miyahara R, Hirooka Y. et al. Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study. Gastrointest Endosc 2015; 82: 287-295
    CrossrefPubMedSearch in Google Scholar
  • 20 Fletcher CDM. Clinicopathologic correlations in gastrointestinal stromal tumors. Hum Pathol 2002; 33: 455
    CrossrefPubMedSearch in Google Scholar
  • 21 Newcombe RG. Improved confidence intervals for the difference between binomial proportions based on paired data. Statist Med 1998; 17: 2635-2650
    CrossrefPubMedSearch in Google Scholar
  • 22 Zhang X-C, Li Q-L, Yu Y-F. et al. Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis. Surg Endosc 2016; 30: 2431-2441
    CrossrefPubMedSearch in Google Scholar
  • 23 Inoue T, Okumura F, Mizushima T. et al. Assessment of factors affecting the usefulness and diagnostic yield of core biopsy needles with a side hole in endoscopic ultrasound-guided fine-needle aspiration. Gut Liver 2016; 10: 51-57
    CrossrefPubMedSearch in Google Scholar
  • 24 Hikichi T, Irisawa A, Bhutani MS. et al. Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol 2009; 44: 322-328
    CrossrefPubMedSearch in Google Scholar
  • 25 Hasegawa T, Matsuno Y, Shimoda T. et al. Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol 2002; 33: 669-676
    CrossrefPubMedSearch in Google Scholar
  • 26 Kobara H, Mori H, Fujihara S. et al. Endoscopically visualized features of gastric submucosal tumors on submucosal endoscopy. Endoscopy 2014; 46: E660-E661
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Fujita K, Kobara H, Mori H. et al. Differences in miRNA expression profiles between GIST and leiomyoma in human samples acquired by submucosal tunneling biopsy. Endosc Int Open 2015; 3: E665-E671
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Khashab MA, Pasricha PJ. Conquering the third space: challenges and opportunities for diagnostic and therapeutic endoscopy. Gastrointest Endosc 2013; 77: 146-148
    CrossrefPubMedSearch in Google Scholar