EUS-Guided Sampling of Suspected GI Stromal Tumors

Hoda, Katherine M.; Rodriguez, Sarah A.; Faigel, Douglas O.

doi:10.1016/j.gie.2007.03.408

Cited by 147 publications

(19 citation statements)

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“…Usually dGISTs appears as hypoechoic and wellvascularized lesion. Two small series reported a significant correlation between the presence of intratumoral vessels on contrast-enhanced or color Doppler EUS and the malignant potential of dGISTs (130,131). EUS provides a precise evaluation of the size, border, layer of origin, echogenicity and heterogeneity of the lesions thus facilitating the differential diagnosis (lipomas, hemangiomas, ectopic pancreas, and cysts) and decision-making process (112).…”

Section: Diagnosismentioning

confidence: 99%

“…EUS provides a precise evaluation of the size, border, layer of origin, echogenicity and heterogeneity of the lesions thus facilitating the differential diagnosis (lipomas, hemangiomas, ectopic pancreas, and cysts) and decision-making process (112). Additionally, EUS allows also fine needle or trucut biopsy with 100% specificity and 84% sensitivity (92,112,131,132). Percutaneous biopsy should be avoided when possible because of the risk for tumor spillage and dissemination.…”

Section: Diagnosismentioning

confidence: 99%

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Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment.Methods: An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST.Results: Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections).Conclusions: dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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“…EUS‐FNA could harvest evaluable materials from SMT and enables diagnosis with an accuracy rate of 70–90% . When EUS‐FNA is repeated more than five passes, its diagnostic yield is similar to that of EUS‐guided trucut biopsy, suggesting that EUS‐FNA is the most reliable and useful tool in the histological diagnosis of SMT . Indications for EUS‐FNA may include pathologically undiagnosed lesions that may potentially require medical or surgical treatment depending on their histology.…”

Section: Differential Diagnosis Of Smtmentioning

confidence: 99%

Submucosal tumors: Comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors

Nishida

Kawai

Yamaguchi

et al. 2013

Digestive Endoscopy

230

211

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Small submucosal tumors (SMT) without symptoms are frequently found by endoscopic and radiological examinations. To find proper diagnostic measures and therapeutic indications for histologically undiagnosed SMT, we reviewed published articles in PubMed between 1990 and March 2013 using the key words 'submucosal tumor' and the name of a specific disease. SMT is observed in a wide range of gastrointestinal (GI) diseases and conditions, including compression by extra-GI organs and lesions, congenital tumors, inflammation, and benign as well as malignant neoplastic lesions. In the diagnosis of diseases and decision-making for therapy, endoscopic ultrasonography (EUS) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) may play a key role. Symptomatic SMT and SMT histologically diagnosed as malignant or potentially malignant tumors such as gastrointestinal stromal tumor (GIST) should be treated by surgery. SMT >5 cm, SMT increasing in size and those with 'high-risk features' including irregular border, heterogeneous internal echo such as anechoic area, and heterogeneous enhancement by contrast media may also be removed by surgery. Laparoscopic approach is feasible for gastric GIST <5 cm and this is considered less invasive than the open approach. Emerging techniques using flexible endoscopes appear less invasive, but require further evidence and are still under clinical study. Correct diagnosis of SMT is challenging; however, EUS and EUS-FNA are useful in the histological diagnosis and clinical decisionmaking. In the future, minimally invasive approaches may be a mainstream of surgical treatment for small SMT.

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“…The usage of larger bore puncture needles or the Tru‐cut needle may help to acquire a greater volume of specimens, although its application may be more difficult compared with the use of a conventional small bore needle [20]. The application of a special immunohistochemical stain may also improve the diagnostic rate for specimens with a small volume [21]. The application of FNA for submucosal tumors provides other advantages.…”

Section: Discussionmentioning

confidence: 99%

The clinical efficacy and safety of EUS‐FNA for diagnosis of mediastinal and abdominal solid tumors – A single center experience

Yang

Liao

et al. 2015

Adv in Digestive Medicine

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Background: Many tumors are small and located around the gastrointestinal (GI) tract, and they are difficult to obtain tissue from for pathological diagnosis by the guidance of conventional methods (sonography or computed tomography. The aim of this study was to analyze the efficacy and benefit of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the clinical diagnosis of solid tumors in the mediastinum and abdomen. Patients and methods: Data from 233 patients with solid tumors on or around the GI tract were reviewed. They had received successful EUS-FNA without on-site cytopathology study. Results: The lesions were classified according to the anatomic location as pancreatic tumors (Group A, n Z 91), mediastinal tumors (including lymph nodes) (Group B, n Z 38), abdominal tumors (including lymph nodes) (Group C, n Z 49), focal transmural thickening of the GI tract (Group D, n Z 6), and submucosal tumors of the GI tract (Group E, n Z 49). The accuracies of pathological diagnosis of malignancy were 79.2%, 76.9%, 93.2%, and 80% for Groups AeD, respectively. The overall accuracy for malignancy was 82.9%. For the submucosal tumors of the GI tract in Group E, FNA cytopathology provided evidence of specific diagnosis all were GI stromal tumor in 47% of the cases, 14% were diagnosed as suspicious (most were of a spindle cell tumor nature), and 39% were considered negative of tumor or non-diagnostic. There were three episodes (1.3%) of complication (GI bleeding, n Z 1; septic fever, n Z 1; gallbladder puncture, n Z 1) which occurred among all patients in this study, and all of them were treated appropriately, with no occurrence of life-threatening events. Please cite this article in press as: Yang S-S, et al., The clinical efficacy and safety of EUS-FNA for diagnosis of mediastinal and abdominal solid tumors e A single center experience, Advances in Digestive Medicine (2015), http://dx.Advances in Digestive Medicine (2015) xx, 1e6Conclusion: EUS-FNA appears to be a very useful tool for obtaining tissue diagnosis for lesions that are inaccessible by the conventional methods and was shown to be a safe and effective technique in the hands of experienced operators. Pathological diagnosis can be obtained for the guidance of clinical management to avoid the more invasive ways, such as surgery or mediastinal scope.

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EUS-Guided Sampling of Suspected GI Stromal Tumors

Cited by 147 publications

References 0 publications

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Submucosal tumors: Comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors

The clinical efficacy and safety of EUS‐FNA for diagnosis of mediastinal and abdominal solid tumors – A single center experience

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