Diagnostic Value of EUS-Guided Fine-Needle Aspiration Biopsy for Gastric Linitis Plastica with Negative Endoscopic Biopsy

Abstract

Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between 2016 and 2020 to evaluate EUS-guided fine-needle aspiration (EUS-FNA) biopsy outcomes in patients with negative endoscopic biopsy findings. A pathological GLP diagnosis was achieved by endoscopic biopsy in 40 patients (74.1%). EUS-FNA biopsy with a 22-gauge needle was performed in 13 of the remaining 14 patients, and GLP diagnosis was confirmed in 10 patients, with a median of three needle passes. The remaining four patients were laparoscopically diagnosed with GLP. The diagnostic ability of EUS-FNA biopsy for GLP was 76.9%, and EUS-FNA biopsy contributed to GLP diagnosis in 18.5% (10/54) of all cases. None of the 13 patients exhibited EUS-FNA biopsy-related adverse events. Univariable and multivariable analyses revealed an absence of superficial ulcerations as a predictor of false-negative endoscopic biopsy findings in patients with GLP. These results suggest EUS-FNA biopsy as a minimally invasive and safe alternative diagnostic modality for GLP in cases where conventional endoscopic biopsy fails to verify malignancy, although prospective studies with larger cohorts are warranted to confirm these findings.

Efficacy for diagnoses of scirrhous gastric cancer and safety of endoscopic ultrasound‐guided fine‐needle aspiration: A systematic review and meta‐analysis

“…Furthermore, the mean duration of these studies was 64 months (standard deviation [SD], 16 months). These four studies were single‐center, retrospective studies and consisted of patients with suspected SGC 8,9,13,14 . The mean overall quality by NOS for the four included studies was 5.5 (SD = 0.58; Table S2).…”

“…4). 13 13 (100) 10 (76.9) N/A ‡ N/A ‡ 0 (0) Assaf A et al 14 10 (100) 9 (90) 3 3 (100) 0 (0) † EUS-FNA diagnostic proportion for scirrhous gastric cancer (definitive diagnosis by EUS-FNA/ patients with SGC). ‡ Details regarding lymph node metastasis were not specified.…”

“…After rapid on‐site evaluation (ROSE), the collected specimens were divided into those for cell blocks and those for injection into formalin for histologic examination. Takada et al 13 . used GF‐UCT260 (Olympus Medical Systems, Tokyo, Japan) and an ALOKA ProSound F75 or an ALOKA ARIETTA 850 processor (Hitachi Aloka Medical, Tokyo).…”

“…After rapid on-site evaluation (ROSE), the collected specimens were divided into those for cell blocks and those for injection into formalin for histologic examination. Takada et al 13 used GF-UCT260 (Olympus Medical Systems, Tokyo, Japan) and an ALOKA ProSound F75 or an ALOKA ARIETTA 850 processor (Hitachi Aloka Medical, Tokyo). A 22-gauge needle EZ Shot 3 Plus (Olympus Medical Systems) or a 22-gauge needle Acquire (Boston Scientific, Natick, MA, USA) was used and stroked 10-15 times combined with 20 mL suction technique.…”

Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report

“…Although the European Society of Gastrointestinal Endoscopy recommends a MIAB or EUS-FNB for the tissue diagnosis of subepithelial lesions, including gastrointestinal stromal tumor (GIST)[ 14 ], there is no standard method for making a tissue diagnosis of GLP. In the previous articles, an EUS-FNB for GLP cases with a negative endoscopic biopsy was reported to be useful in that EUS could directly visualize whether or not the target had been punctured properly, and the positive rates were high with few adverse events (Table 2 )[ 13 , 15 - 17 ]. However, Zhou et al [ 18 ] conversely reported that the diagnostic yield of EMR with the bite-on-bite technique for gastric-infiltrating tumors, including GLP, was 82.2% (23/28).…”