The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

Sekine, Masanari; Asano, Takeharu; Mashima, Hirosato

doi:10.3390/diagnostics12040810

Cited by 9 publications

(13 citation statements)

References 112 publications

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“…European Society of Gastrointestinal Endoscopy recommends EUS as the best diagnostic tool to identify gastric SELs, however, EUS alone is not sufficient 1 . Obtaining sufficient tissue for histopathological examination is crucial for diagnosis of gastric SELs; however, the amount of tissue collected is affected by the size of the tumor 20 . EUS‐FNA is frequently used for tissue sampling in gastric SELs.…”

Section: Discussionmentioning

confidence: 99%

A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images

Zhang

Gong

et al. 2023

J Applied Clin Med Phys

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Background Endoscopic ultrasonography (EUS) is recommended as the best tool for evaluating gastric subepithelial lesions (SELs); nonetheless, it has difficulty distinguishing gastrointestinal stromal tumors (GISTs) from leiomyomas and schwannomas. GISTs have malignant potential, whereas leiomyomas and schwannomas are considered benign. Purpose This study aimed to establish a combined radiomic model based on EUS images for distinguishing GISTs from leiomyomas and schwannomas in the stomach. Methods EUS images of pathologically confirmed GISTs, leiomyomas, and schwannomas were collected from five centers. Gastric SELs were divided into training and testing datasets based on random split‐sample method (7:3). Radiomic features were extracted from the tumor and muscularis propria regions. Principal component analysis, least absolute shrinkage, and selection operator were used for feature selection. Support vector machine was used to construct radiomic models. Two radiomic models were built: the conventional radiomic model included tumor features alone, whereas the combined radiomic model incorporated features from the tumor and muscularis propria regions. Results A total of 3933 EUS images from 485 cases were included. For the differential diagnosis of GISTs from leiomyomas and schwannomas, the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve were 74.5%, 72.2%, 78.7%, and 0.754, respectively, for the EUS experts; 76.8%, 74.4%, 81.0%, and 0.830, respectively, for the conventional radiomic model; and 90.9%, 91.0%, 90.6%, and 0.953, respectively, for the combined radiomic model. For gastric SELs <20 mm, the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the combined radiomic model were 91.4%, 91.6%, 91.1%, and 0.960, respectively. Conclusions We developed and validated a combined radiomic model to distinguish gastric GISTs from leiomyomas and schwannomas. The combined radiomic model showed better diagnostic performance than the conventional radiomic model and could assist EUS experts in non‐invasively diagnosing gastric SELs, particularly gastric SELs <20 mm.

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Section: Discussionmentioning

confidence: 99%

A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images

Zhang

Gong

et al. 2023

J Applied Clin Med Phys

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“…Endoscopic ultrasonography (EUS) is thus recommended for further evaluation. In EUS images, the metastatic tumors generally appeared as slightly hypoechoic lesions (more hyperechoic than the muscular tissue) involving the muscularis propria (fourth layer), mimicking primary subepithelial lesions such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas (92,93). EUS-guided fine-needle aspiration and biopsy (EUS-FNA/B) is currently the gold standard tissue sampling method for SMTs (92,93).…”

Section: Discussionmentioning

confidence: 99%

“…In EUS images, the metastatic tumors generally appeared as slightly hypoechoic lesions (more hyperechoic than the muscular tissue) involving the muscularis propria (fourth layer), mimicking primary subepithelial lesions such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas (92,93). EUS-guided fine-needle aspiration and biopsy (EUS-FNA/B) is currently the gold standard tissue sampling method for SMTs (92,93). Hence, biopsies or EUS-FNA/B in conjunction with immunohistochemistry provides a reliable method to identify metastatic gastric tumors.…”

Section: Discussionmentioning

confidence: 99%

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

Tang

Liu

et al. 2022

Front. Oncol.

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BackgroundGastric metastasis from lung cancer (GMLC) is a rare occurrence. The clinicopathological characteristics, outcomes, and prognostic factors remain largely elusive.MethodsWe conducted a systematic review on case reports and case series of GMLC by scanning MEDLINE, Embase, and ISI Web of Knowledge. Data involving the clinicopathological features, treatment, and outcomes were extracted and analyzed. Survival analysis was performed using Kaplan–Meier method. The Cox proportional hazards regression model was used to identify potential prognostic factors associated with survival. Furthermore, a case of metastatic gastric adenocarcinoma of pulmonary origin with epidermal growth factor receptor (EGFR) L858R+T790M mutation was also described and included.ResultsSeventy-eight records involving 114 cases (including ours) were finally included. The median age on admission was 65 years with a male predominance of 79.8%. Lung adenocarcinoma (42.1%), located in the right upper lobe (30.3%), was the most frequent primary tumor. Bleeding (36.7%) and abdominal pain (35.8%) were the two most common symptoms. Endoscopically, gastric lesions were typically presented as elevated lesions with or without volcano-like ulceration, or ulcerative lesions, mostly involving the gastric corpus. The median overall survival time and survival time after diagnosis of metastatic cancer were 11 months [95% confidence interval (CI): 7–14] and 4.5 months (95% CI: 3–9), respectively. The survival analyses revealed that surgical interventions (including lung surgery and/or abdominal surgery) and systemic therapy (including chemotherapy, radiotherapy, and/or targeted therapy) seemed to be positive prognostic factors for both overall survival and survival after diagnosis of metastatic cancer.ConclusionsClinicians should be alerted to the occurrence of gastric metastasis in lung cancer patients. Comprehensive evaluation and appropriate treatment for specific patients may improve the survival rate of GMLC patients.

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“…Unlike neoplasms that develop in or involving the gastric epithelium, such as gastric cancer and lymphoma, diagnostic difficulty exists in subepithelial lesions because the neoplasms are covered by nonneoplastic gastric mucosa; thus, pathological diagnosis via conventional endoscopic biopsy is usually challenging. [1][2][3] Furthermore, because most small gastric subepithelial lesions grow slowly or remain unchanged for years, endoscopic surveillance without pathological diagnosis is generally acceptable. For instance, annual to semiannual esophagogastroduodenoscopy examinations are recommended in the Japanese guidelines, unless ulceration on the surface, irregular morphology, or tumor growth are present.…”

Section: Introductionmentioning

confidence: 99%

“…Most of these lesions are small (≤20 mm) and are incidentally identified without association with specific symptoms. Unlike neoplasms that develop in or involving the gastric epithelium, such as gastric cancer and lymphoma, diagnostic difficulty exists in subepithelial lesions because the neoplasms are covered by nonneoplastic gastric mucosa; thus, pathological diagnosis via conventional endoscopic biopsy is usually challenging 1–3 . Furthermore, because most small gastric subepithelial lesions grow slowly or remain unchanged for years, endoscopic surveillance without pathological diagnosis is generally acceptable.…”

Section: Introductionmentioning

confidence: 99%

Results of the interim analysis of a prospective, multicenter, observational study of small subepithelial lesions in the stomach

Iwamuro

Mitsuhashi

Inaba

et al. 2023

Digestive Endoscopy

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ObjectivesLong‐term outcomes of gastric subepithelial lesions have not been elucidated. To reveal the natural history, we initiated a prospective, 10‐year follow‐up of patients with small (≤20 mm) gastric subepithelial lesions in September 2014. Here, we report the results of an interim analysis of a prospective observational study.MethodsIn total, 567 patients with 610 lesions were prospectively registered between September 2014 and August 2016. The location, size, morphology, and number of subepithelial lesions were recorded on a web‐based case report form. This study has been conducted as an Academic Committee Working Group of the Japan Gastroenterological Endoscopy Society.ResultsThe endoscopic follow‐up period was 4.60 ± 1.73 years (mean ± standard deviation), and survival data were investigated for 5.28 ± 1.68 years. This interim analysis revealed that the estimated cumulative incidence of a size increase ≥5 mm, after accounting for patients' death and resection of the tumor as competing risk events, was 4.5% at 5 years. In addition, the estimated cumulative incidence of lesion size increase ≥5 mm or resection of lesions was 7.9% at 5 years, and that of size increase ≥10 mm or resection of lesions was 4.5% at 5 years.ConclusionThese results indicate that approximately one in 13 patients with small (≤20 mm) gastric subepithelial lesions may require resection or further investigation for increased tumor size (≥5 mm) within 5 years.

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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

Cited by 9 publications

References 112 publications

A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images

A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

Results of the interim analysis of a prospective, multicenter, observational study of small subepithelial lesions in the stomach

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