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

Akahoshi, Kazuya; Tamura, Shinichi; Akahoshi, Kazuaki; Shiratsuchi, Yuki; Koga, Hidenobu; Oya, Masafumi; Ohishi, Yoshihiro; Koga, Tadashi

doi:10.1002/ajum.12382

Australas J Ultrason Med

2024

DOI: 10.1002/ajum.12382

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

Kazuya Akahoshi,

Shinichi Tamura,

Kazuaki Akahoshi

et al.

Abstract: Introduction/PurposeFor gastric subepithelial lesions (GSELs) showing a hypoechoic mass (HM) on endoscopic ultrasonography (EUS) imaging, the utility of EUS‐guided tissue acquisition using conventional fine‐needle aspiration needles (EUS‐TA‐CFNAN) and the frequency of histological types remain unclear. This study aimed to examine this issue.MethodsThis prospective observational study enrolled 291 consecutive patients who underwent EUS‐TA‐CFNAN for GSELs showing an HM (GSELHM) on EUS imaging. Immunohistochemica… Show more

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A stab in the dark

Whalley

2024

Australas J Ultrason Med

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Procedural guidance with ultrasound is challenging traditional medicine. And for good reasonprecision is an ally whenever you are inserting a needle into a human body. With some imagination, I am able to conjure up a gruesome Hollywood-esque image of someone gripping a syringe in a gloved fist and thrusting it towards a body with the intention of hitting a target under the skin. In my mind, there is an element of chance as to whether the needle hits the intended anatomical target. It's a stab in the dark. In a more nuanced and stable clinical scenario, the insertion point is carefully considered and the odds of missing may be relatively low. But no matter how low, it seems intuitively sensible to use any imaging guidance available. And increasingly, that guidance is provided by ultrasound. Ultrasound has been established as a helpful addition to inserting intravenous lines, taking biopsies and draining free fluid, to name but a few.If one assumes that the person inserting a needle has absolutely no knowledge of underlying anatomy and is simply taking a stab whilst hoping it will hit its spot then it is easy to perceive the massive benefit of ultrasound-guided procedures. But that simply isn't true. Medical students spend many hours learning about surface anatomy and how it relates to the underlying layers of tissue, muscle and bone below the skin. Doctors have a great understanding of anatomy and use their hands to palpate for certain underlying structures such as bony processes, tendons and veins, in order to piece together an image in their mind about the underlying anatomy. Anyone who has had blood taken knows that those technicians who do this are adept at feeling the anatomy on the inside of the elbow to find a vein to puncture and drain blood from no matter how deep it is. It is a well-honed skill.But taking blood is one thing, injecting substances is quite another. Intra-articular injections for the treatment of joint osteoarthritis have been popular for some time and are safely performed using anatomical landmarks only. But increasingly, practitioners are using ultrasound to guide needle placement. In this issue of AJUM, Oo et al. 1 have performed a systematic review of ultrasound-guided injections and concluded that clinical outcomes are superior compared with landmark-guided

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A stab in the dark

Whalley

2024

Australas J Ultrason Med

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EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided

Giri,

Sundaram

2024

Australas J Ultrason Med

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We read with great interest the study by Akahoshi et al., 1 highlighting the diagnostic outcome of endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) for gastric subepithelial hypoechoic masses. The authors enrolled 291 cases prospectively and reported a diagnosis rate of 80.1%, with most cases being gastrointestinal stromal tumours. The diagnostic yield was lower for lesions located in the antrum and those smaller than 2 cm. However, there are a few concerns that need to be addressed.A meta-analysis by Facciorusso et al., 2 analysing 10 studies, reported a greater proportion of sample adequacy (94.9% vs. 80.6%), a higher rate of optimal histologic core procurement (89.7% vs. 65%) and a higher rate of diagnostic accuracy (odds ratio, 4.10; 95% CI, 2.48-6.79) with a lower number of passes in cases using fine-needle biopsy (FNB) needle. Another metaanalysis comparing EUS-guided tissue acquisition (TA) with mucosal incision-assisted biopsy (MIAB) from subepithelial lesions (SEL) reported a lower positive diagnostic yield with EUS-TA than with MIAB (risk ratio, 0.83; 95% CI, 0.71-0.98). However, on subgroup analysis, the diagnostic yield was comparable when using a FNB needle (RR, 0.93; 95% CI, 0.83-1.04). 3 Thus, using a FNB needle could have helped improve the diagnostic yield, especially in lesions smaller than 2 cm. 4 The choice of optimal suction technique for SELs remains a subject of debate, and Akahoshi et al. 1 used dry suction in all cases. A randomised trial comparing standard suction and wet suction during EUS-FNA did not show any significant difference in the cellularity of the specimen. 5 Another retrospective study reported comparable diagnostic accuracies with standard suction and slow stylet pull techniques during EUS-FNB. 6 However, both these studies were underpowered. A previous network meta-analysis reported slightly better outcomes with wet suction in terms of lower odds of bloodiness. 7 Thus, further studies are required to determine the optimal suction technique for EUS-TA from SELs.Akahoshi et al. 1 used rapid on-site evaluation (ROSE) in all cases. However, ROSE may not be available at all centres, and in such cases, macroscopic on-site evaluation (MOSE) may Authorship statementBoth SG and SS contributed to the conception and preparation of this letter, to the analysis of the results and to the writing of the manuscript.

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

Cited by 2 publications

References 34 publications

A stab in the dark

A stab in the dark

EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided

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