EUS-guided tissue sampling with a 20-gauge core biopsy needle for the characterization of gastrointestinal subepithelial lesions: A multicenter study

Antonini, Filippo; Delconte, Gabriele; Fuccio, Lorenzo; Nucci, Germana de; Fabbri, Carlo; Armellini, Elia; Frazzoni, Leonardo; Fornelli, Adele; Magarotto, Andrea; Mandelli, Enzo Domenico; Occhipinti, Pietro; Masci, E.; Manes, Gianpiero; Macarri, Giampiero

doi:10.4103/eus.eus_1_18

Cited by 33 publications

(24 citation statements)

References 15 publications

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“…Gastric SMTs can be exactly diagnosed by EUS [6,7]. Considering the malignant potential of some SMTs, especially when the tumor size is more than 20 mm, resection is recommened for the lesion.…”

Section: Discussionmentioning

confidence: 99%

Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus

Guo

Wang

et al. 2020

BMC Gastroenterol

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Background and aims: Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed fashion in the gastric fundus. The present study aims at exploring whether direct EFTR can be a simple, effective and safe procedure to treat intraluminal-growth submucosal tumors originating from the muscularis propria. Methods: The patients with intraluminal-growth submucosal tumors originating from the muscularis propria in gastric fundus treated by direct EFTR between 01 January 2017 and 01 September 2018 were retrospectively reviewed. In addition, we analyzed the patients with intraluminal-growth submucosal tumors originating from the muscularis propria in gastric fundus treated by traditional EFTR. The differences in tumor resection time, costeffectiveness, and complication rate were evaluated. Results: Forty patients were enrolled in the present study, 20 patients of which were in the direct EFTR group and 20 patients of which were in the traditional EFTR group. En-bloc resections of gastric tumors were successfully performed in all 40 cases. There was no significant difference in the average tumor size of the two groups (24.3 ± 2.9 mm in direct EFTR group verus 24.0 ± 2.6 mm in the traditional group, p = 0.731), but significant difference existed in the operative time between two groups (35.0 ± 8.2 min in direct EFTR group verus 130.6 ± 51.9 min in the traditional group, p<0.05). No complications, such as postoperative bleeding and perforation, occurred in any groups. Conclusions: Direct EFTR is a safe, simple and cost-effective procedure for SMTs with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus.

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Section: Discussionmentioning

confidence: 99%

Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus

Guo

Wang

et al. 2020

BMC Gastroenterol

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“…EUS-FNB PC needles have been conceived to obtain more tissue and ideally to provide histological specimen (core biopsy). Studies on core biopsy needles were mainly conducted on patients with pancreatic masses, while only a few studies are available looking at characterization of SELs 7 20 21 22 . In the first experience of Iglesias-Garcia et al on heterogeneous study population with intestinal and extra-intestinal lesions, EUS-FNB with 19G-PC was technically feasible in 98.2 % of cases (112/114).…”

Section: Discussionmentioning

confidence: 99%

“…Only a single case of post-procedural bleeding was recorded 22 . Recently, a new 20G-PC needle has been developed, which is expected to be a balanced compromise between flexibility, facility of use proper of the smallest needles, and quality of the tissue sampling, typical of the larger needle, providing echo endoscopists a new tool to accurately target lesions, regardless of their size or location 7 . Antonini et al published the first experience with this needle in a multicenter retrospective study for the diagnosis of SELs.…”

Section: Discussionmentioning

confidence: 99%

“…Antonini et al published the first experience with this needle in a multicenter retrospective study for the diagnosis of SELs. A total of 50 SELs were included and after a mean number of passes of 2.2 (range 1 – 4), definitive diagnosis with full histological assessment including IHC was obtained in 88 % of patients (44/50) without any major complications 7 .…”

Section: Discussionmentioning

confidence: 99%

“…However, tissue diagnosis is often required, especially in neoplasms for which immunohistochemistry (IHC) is mandatory, such as gastrointestinal stromal tumors (GISTs). EUS needles of different size and shape have been used, with variable success/complication rates 4 5 6 7 . Recently, a new needle with reverse bevel technology has been developed to simultaneously obtain cytological aspirates and histological core samples, thereby leading to an ideal EUS-guided fine needle biopsy (EUS-FNB) 8 9 10 11 .…”

Section: Introductionmentioning

confidence: 99%

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EUS-guided sampling with 25G biopsy needle as a rescue strategy for diagnosis of small subepithelial lesions of the upper gastrointestinal tract

et al. 2018

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Background and study aims This study was designed to evaluate the impact of additional tissue obtained with endoscopic ultrasound (EUS)-guided 25-gauge core biopsy needle (25G-PC) following an unsuccessful fine-needle biopsy (FNB) performed with larger-bore needles for the characterization of gastrointestinal subepithelial lesions (GI-SELs). Patients and methods We prospectively collected and retrospectively analyzed information in our database from January 2013 to June 2017 for all patients with GI-SELs who received a EUS-guided FNB (EUS-FNB) with 25G-PC during the same procedure after failure of biopsy performed with larger-bore needle. Diagnostic yield, diagnostic accuracy and procedural complications were evaluated. Results Sixteen patients were included in this study, 10 men and 6 women, median age 67.8 (range 43 to 76 years). Five patients were found to have a SEL localized in the distal duodenum, five in the gastric antrum, two in the gastric fundus and four in the gastric body. The mean size of the lesions was 20.5 mm (range 18 – 24 mm). EUS-FNB with 25G-PC enabled final diagnosis in nine patients (56.2 %). Regarding the subgroup of duodenal lesions, the procedure was successful in four of five (80 %). Final diagnoses with EUS-guided sampling were GIST (n = 6), leiomyoma (n = 2) and metastatic ovarian carcinoma (n = 1). No procedure-related complications were recorded. Conclusion In patients with small GI-SELs, additional tissue obtained with 25G-PC could represents a “rescue” strategy after an unsuccessful procedure with larger-bore needles, especially when lesions are localized in the distal duodenum.

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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

Akahoshi,

Tamura,

Akahoshi

et al. 2024

Australas J Ultrason Med

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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. Immunohistochemical analysis was performed for all EUS‐TA‐CFNAN and surgically resected specimens. The main outcome measures were the technical results of EUS‐TA‐CFNAN and the frequency of histological types in GSELHM.ResultsThe endoscopic ultrasound‐guided tissue acquisition using conventional fine‐needle aspiration needle diagnosis rate for GSELHM was 80.1% (95% confidence interval [CI]: 75.0–84.5, 233/291). It was significantly lower for antrum (P = 0.004) and lesions smaller than 2 cm (P = 0.003). There were no adverse events. The immunohistochemical diagnoses of EUS‐TA‐CFNAN included 149 cases of gastrointestinal stromal tumour (GIST) (51.2%), 48 cases of leiomyoma (16.5%), 11 cases of schwannoma (3.8%), 8 cases of the ectopic pancreas (2.7%), 5 cases of subepithelial lesion like cancer (1.7%), 12 cases of other lesions (4.1%), and 58 cases of undiagnosable lesions (19.9%). The frequency of malignant or potentially malignant tumour in GSELHM was 55.0% (95% CI: 49.1–60.8, 160/291). Surgery was performed in 149 patients according to the conclusive EUS‐TA‐CFNAN results, in which the diagnostic accuracy of EUS‐TA‐CFNAN was 97.3% (95% CI: 94.7–99.9, 145/149).ConclusionThe use of EUS‐TA‐CFNAN for GSELHMs is safe and accurate. Gastric subepithelial lesions showing a hypoechoic mass have a reasonably high possibility of containing malignant or potentially malignant tumours, including GISTs.

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EUS-guided tissue sampling with a 20-gauge core biopsy needle for the characterization of gastrointestinal subepithelial lesions: A multicenter study

Abstract: In this multicenter study, we found that EUS-FNB with the new 20G core needle is an effective and safe method for the diagnosis of SELs with a high rate of producing adequate histological material and high diagnostic accuracy even from difficult-to-approach anatomical locations.

Cited by 33 publications

References 15 publications

Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus

Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus

EUS-guided sampling with 25G biopsy needle as a rescue strategy for diagnosis of small subepithelial lesions of the upper gastrointestinal tract

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

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