Efficacy of single-incision needle-knife biopsy for sampling subepithelial lesions

Abstract

Background and study aims Single-incision needle-knife (SINK) biopsy is a diagnostic method for acquiring tissue samples for subepithelial lesions (SELs). A single linear incision is made in the overlying mucosa and tissue samples are obtained by passing conventional biopsy forceps through the opening and deep into the lesion. The aim of this study was to describe the efficacy and safety of this technique. Patients and methods Consecutive patients who underwent SINK biopsy for an upper gastrointestinal SEL between October 2013 and September 2015 were retrospectively reviewed. Results Forty-nine patients underwent 50 SINK biopsies. Sufficient sampling for a definite pathologic diagnosis was obtained in 42 (86 %) cases, with 91 % (40/44) having sufficient sample to perform immunohistochemistry when deemed clinically relevant. Of the 26 patients with prior non-diagnostic biopsies or FNA, a specific diagnosis was obtained in 85 % (22/26). There were no significant adverse events. Conclusions SINK biopsy is a safe and feasible strategy for obtaining a definitive tissue diagnosis with immunohistochemistry for SELs.

EUS-guided 22-gauge fine needle biopsy versus single-incision with needle knife for the diagnosis of upper gastrointestinal subepithelial lesions: a randomized controlled trial

“…When IHC was deemed necessary for diagnosis, in this study SINK was superior to EUS-FNB for obtaining tissue samples which were suitable for IHC. These results are similar to a study by Shimamura et al in which 91 % of samples obtained by SINK were suitable for immunohistochemical evaluation [12]. Of note, although the 22 % difference was not statistically significant, from clinical standpoint the difference could be considered as a significant finding given the pivotal role of IHC in proper diagnosis of gastrointestinal SETs.…”

“…Of note, the 76 % diagnostic accuracy for EUS-FNB in our study was comparable to other studies reporting rates of 75 % to 92 % for EUS-FNB using similar 22-gauge ProCore needle [6,18,19]. In the same way, the 89.28 % diagnostic accuracy of SINK was comparable to the rates of 87 % to 93 % reported in other studies [10][11][12].…”

“…One study reported SINK to have a diagnostic yield of 93 % and found it superior to EUS-FNA in providing a final histological diagnosis (75 % vs. 12.5 %; P = 0.23) [10]. In the other two studies, however, the performance of SINK was reported as 89 % diagnostic accuracy in one [11] and 86 % tissue sufficiency to reach a definite pathologic diagnosis in the other [12]. Small, retrospective studies have inherent issues including being prone to biases and confounding factors.…”

“…However, a very recent study suggests a potential role for EUS-FNB for the acquisition of adequate samples for IHC analysis [17]. There are only three studies evaluating performance of SINK [10][11][12]. All of them were retrospective studies with between 14 to 49 patients.…”

“…De la Serna et al introduced the SINK technique in a retrospective series of 14 cases and reported a diagnostic yield of 93 % [10]. In two other retrospective studies, including 31 and 49 patients, the diagnostic yield was 87 % and 91 %, respectively [11,12]. Performance of the SINK technique with EUS-FNB is currently unknown.…”