Endoscopic Sonographically Guided Fine-Needle Aspiration Yield in Submucosal Tumors of the Gastrointestinal Tract

Abstract

Objective. To study the yield of endoscopic ultrasonographically guided fine-needle aspiration cytologic examination in the diagnosis of submucosal masses. Methods. From 1999 to 2003, 10 patients underwent ultrasonographically guided fine-needle aspiration for the cytologic diagnosis of submucosal masses in our institution. The endoscopic ultrasonography records and the cytology database were consulted, and the reports were analyzed, as were slide material and the technical aspects related to these procedures. All procedures were performed under conscious sedation and cardiorespiratory monitoring on an outpatient basis. Ten patients (4 men and 6 women; mean age, 60.8 years) were studied. Results. Eight lesions were located in the stomach, and 2 were located in the esophagus, with a mean diameter of 3.3 cm. An experienced cytopathologist was present on-site during all procedures for assessment of adequacy and preliminary cytologic examination. Cytologic diagnoses were obtained in 8 cases as follows: 6 gastrointestinal stromal tumors, 1 organizing submucosal hematoma, and 1 low-grade mucosa-associated lymphoid tissue-associated lymphoma. Two cases consisted of scant gastric epithelium only and were considered nondiagnostic. The cytologic diagnoses guided further clinical treatment. Conclusions. Ultrasonographically guided fine-needle aspiration with cytopathologic analysis has a high accuracy rate (80%) for diagnosing submucosal lesions. These findings potentially affect clinical decision making. Key words: endoscopic ultrasonography; fineneedle aspiration; submucosal tumors. he term submucosal tumor (SMT) refers to any protrusion or indentation observed through the gastrointestinal lumen having an intact mucosal surface and discovered either incidentally during routine endoscopy or because of associated symptoms such as abdominal pain, dysphagia, and gastrointestinal bleeding.1 These symptoms can be related either to the presence of intramural masses or to external compression of the gastrointestinal tract wall.Endoscopy alone has suboptimal accuracy of as low as 40% for identifying the cause of submucosal bulges. 2Usually the mucosal surface is normal, and conventional forceps biopsy results are frequently negative. Other noninvasive imaging methods such as transabdominal ultrasonography and computed tomography are also suboptimal for evaluating submucosal indentations. 3Endoscopic ultrasonography (EUS) combines the endoscopic view with ultrasonographic images generated by a

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“…Because endoscopic biopsy may not be revealing as a result of the submucosal nature of the tumor, EUS has recently evolved as a vital diagnostic modality for GISTs [11]. The ability to perform EUS fine-needle aspiration has been associated with a diagnostic accuracy of 80%-85% [12,13]. Percutaneous biopsy should rarely be used because it is associated with a significant risk for tumor rupture, dissemination, and hemorrhage.…”

Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the diagnosis of diffuse gastrointestinal lesions with inconclusive endoscopic biopsies

“…Furthermore, they found that EUS-FNA was diagnostic in 21 of 24 lesions that were negative on both brush cytology and mucosal forceps biopsy. This study and others concluded that EUS-FNA should be the diagnostic procedure of choice when standard methods, such as endoscopic mucosal forceps biopsy, fail to provide a definitive diagnosis (16)(17)(18)(19).…”

Diagnosis of Linitis Plastica–Type Gastric Adenocarcinoma by Endoscopic Ultrasound-Guided Fine Needle Aspiration

“…Those authors found that EUS-FNA had a sensitivity of 89% in the diagnosis of gastrointestinal lesions. Additionally, in a smaller series of 10 cases, Arantes et al 11 found that EUS-FNA had a sensitivity of 80% for submucosal tumors of the gastrointestinal tract.…”