Endoscopic ultrasound‐guided fine‐needle aspiration cytology in the diagnosis of the gastrointestinal stromal tumor of the stomach

Abstract

BackgroundThis study aims to evaluate the usefulness of endoscopic ultrasound‐guided fine‐needle aspiration cytology (EUS‐FNAC) in the diagnosis of the gastric gastrointestinal stromal tumor (GIST).MethodsWe retrospectively investigated the efficacy and accuracy of EUS‐FNAC in the diagnosis of gastric GIST. Cytological smears and cytoblock sections including immunohistochemistry and mutational studies from patients diagnosed as gastric GISTs were retrieved.ResultsThirty patients (mean age 68.8 years, range 32‐88 years, Male:Female 1:1.7) were diagnosed by cytological and cytoblock study to have GIST. The size of tumors ranged from 1.6 to 25 cm (mean 6.0 cm). 7 (23%) cases were incidentally discovered. Location was: gastric body 13 (43.3%), fundus 8 (26.7%), antrum 7 (23.3%), cardia 2 (6.7%). The study of removed tumors was correlated with the cytological findings. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 75%, 100%, 100%, 46%, and 96%. There were no false‐positive cases. The preoperative risk assessment of 27 cases with cytoblock were: none 3 (11.1%), very low 8 (29.6%), low 12 (44.4%), high 3 (11.1%), insufficient clinical data 1 (3.7%). The follow‐up varied from 2 to 120 months (mean 46.7 months). Only 1 patient of the high‐risk group died. The most frequent mutations found were those of c‐KIT in exon 11.ConclusionsPathological diagnosis was based on a combination of cytological, histopathological, and immunohistochemical features. EUS‐FNAC is a reliable, accurate, and safe method for the diagnosis of GIST. The cytoblock allows tumor risk classification and mutational study of the cases.

Efficacy and histologic frequencies of endoscopic ultrasonography‐guided tissue acquisition using conventional fine‐needle aspiration needles for gastric subepithelial hypoechoic mass

“…22 In addition, the reported accuracy of preoperative diagnosis of EUS-TA-CFNAN using 22 or 25G needles in surgically resected GSEL cases ranged from 81.8% to 96.0%. 14,15,25,26 Accuracy in this study was also high (97.3%). The reported adverse event rates were low (0-4.5%), 27 while in our series the corresponding rate was 0%.…”

Ki‐67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification

“…Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has become increasingly used for the preoperative diagnosis of GIST due to the unique intramural or submucosal location of the tumor. [10][11][12][13] The diagnostic performances of EUS-FNA can be further enhanced by performing rapid on-site evaluation during the biopsy. [14][15][16] It has been reported that EUS-FNA has high sensitivity and diagnostic yield (88%-100%) with low incidences of complications including bleeding and infection (0%-2.6%).…”

“…17 Compared to the biopsy, EUS-FNA offers a safer and convenient option and thus has been incorporated into the routine practice. 13,18 Recently, the fine-needle core biopsy has gained interest in the diagnosis of GIST, because it increases tissue sampling yield, allowing for more extensive histologic workup. 19,20 However, FNA cytology still provides a comparable preoperative tumor sampling.…”

“…Endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA) has become increasingly used for the preoperative diagnosis of GIST due to the unique intramural or submucosal location of the tumor 10–13 . The diagnostic performances of EUS‐FNA can be further enhanced by performing rapid on‐site evaluation during the biopsy 14–16 .…”

“…It has been reported that EUS‐FNA has high sensitivity and diagnostic yield (88%–100%) with low incidences of complications including bleeding and infection (0%–2.6%) 17 . Compared to the biopsy, EUS‐FNA offers a safer and convenient option and thus has been incorporated into the routine practice 13,18 . Recently, the fine‐needle core biopsy has gained interest in the diagnosis of GIST, because it increases tissue sampling yield, allowing for more extensive histologic workup 19,20 .…”