Canalization technique to obtain deep tissue biopsy of gastrointestinal subepithelial tumors as an alternative to conventional known techniques

Abstract

Background and Objectives:The most accurate technology to detect and diagnose subepithelial tumors (SETs) is the endoscopic ultrasonography (EUS) combined with puncture techniques, such as the endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) or the endoscopic ultrasonography-guided fine-needle biopsy. Going further in the improvement of the results of tumor samples obtained endoscopically to diagnose the SETs, the canalization technique guided by miniprobes (MPs) to obtain biopsies of SET could be an alternative to EUS-FNA. The objective of this study is to analyze the results of samples obtained by this procedure.Materials and Methods:A multicenter, retrospective study of a review of a database of 32 consecutive patients with a SET in the digestive tract, from 2000 to 2015 was conducted. All patients underwent EUS-performed by MP, to define the size, internal echostructure, and layer of origin of tumor. Once the echostructure was defined, it proceeded to the canalization technique to arrive to the tumor tissue.Results:The average diameter of SETs in this series (32 patients) was about 21.6±11 mm (range: 5–41 mm). The diagnostic accuracy was 28/32, 87.50% (Confidence interval 95%: 76.04%–98.99%), and there were no major complications. All procedures were performed on outpatients, none of which required additional hospitalization. The 50% of patients were operated or endoscopically resected and in all cases, the previous pathological diagnosis was confirmed.Conclusions:This is a feasible, safe, and effective procedure that allows to access to inside of SET to obtain deep biopsies. Tumor samples obtained by deep biopsy, with prior performing of the canalization technique guided by MP, were sufficient for histopathological and immunohistochemical diagnosis and similar to those obtained with other known methods (FNA Trucut, ProCore®, etc.). However, more prospective comparative studies with a larger number of patients and different specialists carrying out the procedure to reach a higher statistical significance are necessary.

KIT and platelet-derived growth factor receptor α wild-type gastrointestinal stromal tumor associated with neurofibromatosis type 1: Two case reports

“…Patients with NF-1 and abdominal symptoms should be treated with a high index of clinical suspicion and thoroughly evaluated to rule out multiple tumors[13-15]. Ultrasonography is an effective and safe method for the diagnosis of abdominal diseases[16-18]. If the symptoms of gastrointestinal bleeding occur in patients with NF-1, then endoscopic ultrasonography should be performed first[19-22].…”

Randomized controlled trial comparing a conventional needle and a novel needle for endoscopic ultrasound (EUS)-guided histology of peripancreatic masses

“…Although diagnostic accuracy is generally high on a cytological basis for pancreatic ductal adenocarcinoma (PDAC), certain neoplasms such as neuroendocrine tumors, metastatic tumors, and lymphomas need to be diagnosed through histological analysis because the architecture of the core tissue needs to be determined or immunohistochemical analysis needs to be performed. [ 1 ] Sometimes, distinguishing an inflammatory lesion caused by reaction and regeneration from a well differentiated neoplasm based solely on cytological evaluation can be difficult. [ 2 ] Moreover, the National Comprehensive Cancer Network (NCCN) guidelines recommend molecular profiling of tumor tissue in pancreatic cancer and they suggest that knowledge of potentially actionable mutations including Kirsten Rat Sarcoma Viral Oncogene Homologue ( K-ras ) mutations can change clinical management.…”

Advances in the prevention and treatment of esophageal stricture after endoscopic submucosal dissection of early esophageal cancer

“…[ 7 , 8 , 9 ] Because of its unique ability to locate lesions, endoscopic ultrasound facilitates the detection, staging, and treatment of esophageal diseases, [ 10 , 11 ] which is of immense significance for the determination of tumor size, margin, and internal echo structure. [ 12 ] However, postoperative esophageal stricture is a major ESD-related complication, the incidence of which is associated with the size of the lesion and the range of circumferential mucosal defects; [ 13 ] it can cause severe dysphagia and an appreciable decrease in the quality of life of patients, thus becoming a major issue to be tackled after operation. Here, we review more comprehensively recent methods for the prevention and treatment of post-ESD esophageal stricture.…”