Utility of endoscopic ultrasound‐guided fine‐needle aspiration cytology in rapid on‐site evaluation for the diagnosis of gastric submucosal tumors: Retrospective analysis of a single‐center experience

Abstract

Background Recently, there have been reports of endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) cytology being used for the diagnosis of various kinds of tumors. This method has also been adopted in the diagnosis of gastric submucosal tumors (SMTs). The aim of this study was to analyze the utility of EUS‐FNA cytological examination in rapid on‐site evaluation (ROSE) for gastric SMTs. Methods Retrospective analyses of the cytological specimens of EUS‐FNA in ROSE for gastric SMTs and determination of the diagnostic accuracy of EUS‐FNA combined with immunohistochemical analysis of cell blocks and surgically resected specimens were performed. Results A total of 110 patients were enrolled in this study. The most common cytodiagnosis was spindle cell tumor (62 patients, 55.5%), followed by negative for tumor (34 patients), and malignant lymphoma and adenocarcinoma (five patients each). Cell blocks were prepared for 60 of the patients (96.8%), cytologically diagnosed with spindle cell tumor. Immunohistochemical analyses using cell block revealed gastrointestinal stromal tumor (GIST, c‐kit+/desmin−, 49 patients) and leiomyoma (desmin+/c‐kit−, five patients). Thus, using EUS‐FNA specimens, 83.1% of GIST patients were pre‐operatively diagnosed. Conclusions EUS‐FNA cytological examination in ROSE for gastric SMTs aided in the collection of sufficient amounts of tumor tissues for preparing cell blocks. This method led to a high rate of accurate pre‐operative diagnosis in patients with gastric SMTs.

Endoscopic ultrasound‐guided fine needle aspiration cytology diagnosis of upper gastrointestinal tract mesenchymal tumors: Impact of rapid onsite evaluation and correlation with histopathologic follow‐up

“…We observed more tumors were precisely classified on cytology in cases with ROSE as compared to the cases without ROSE (n = 44 vs n = 30, respectively, P < .05) (Table 2). Similarly, Sandoh et al in a study of 120 cases, while evaluating role of ROSE, found 60/62 cases of spindle cell tumor had available cell block material and concluded the importance of ROSE in getting adequate material for preoperative diagnosis 2 . Many of our nondiagnostic cases (9/11, 82%) had cell block material available and was essentially either paucicellular or nonrepresentative.…”

“…With the increasing demand for additional ancillary testing such as identifying mutations for potential benefits of targeted therapy, it is essential to get adequate sample via EUS‐FNA. Rapid onsite evaluation (ROSE) performed at the time of EUS‐FNA procedure has been shown to be a useful method to ensure adequate sampling and triage of the specimen for both diagnostic and further ancillary testing 2 . This study evaluated the role of EUS‐FNA in submucosal and intramural/muscular wall mesenchymal lesions by cytology and histology correlation.…”

Usefulness and problems of cytological examination by endobronchial ultrasound‑guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: A retrospective single‑centre study

“…Improvement in the sampling technique and/or method might be required for these patients. The presence of the cytologist at the time of obtaining the cytological specimens and performance of ROSE improved the detection of the targeted lesions in various organs, according to previous studies (11,12). It has been reported that yields of the conventional TBNA with ROSE and EBUS-TBNA with or without ROSE were higher than those of the conventional TBNA without ROSE, although the rates of granuloma detection were not significantly different (7).…”

Advancements in the Diagnosis of Gastric Subepithelial Tumors

“…Massive studies have already been published regarding the diagnostic yield of EUS-FNAB. 22 - 56 A meta-analysis published in 2016 reports that EUS-guided sampling of upper gastrointestinal subepithelial lesions is safe, but has a moderate diagnostic ability (59.9%) regardless of techniques of FNA/FNB/Tru-Cut needle biopsy or the needle diameter used for puncture. 57 Conversely, a successive meta-analysis reveals that sampling ability of FNA (80.6%) is significantly lower to that of FNB (94.9%), but increase with the help of rapid on-site evaluation.…”