Prospective comparative study of endoscopic ultrasonography-guided fine-needle biopsy and unroofing biopsy

Park, Jihye; Park, Jun Chul; Jo, Jeong Hyeon; Kim, Eun Hye; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

doi:10.1016/j.dld.2019.01.028

Cited by 12 publications

(29 citation statements)

References 21 publications

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“…Kobara et al reported a mucosal incision method in which a small incision is made in the mucosa, a tunnel to the submucosal layers is formed, and the SMT is biopsied with forceps [23]. Other methods such as using a snare simultaneously to expose mucosa have also been reported, and they are also achieving good results [24]. Thus, MCB is thought to have a high diagnostic yield because the tumor is visually recognized and biopsied.…”

Section: Discussionmentioning

confidence: 99%

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Examine the Availability and Safety of Mucosal Cutting Biopsy Technique for Diagnosis of Gastric Submucosal Tumor

Mizukami

Matsunari

Ogawa

et al. 2019

Gastroenterology Research and Practice

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Objectives. Differentiating gastrointestinal stromal tumor (GIST) from other submucosal tumors (SMTs) is important in diagnosing SMT. GIST is an immunohistological diagnosis that cannot be made from images alone. Tissue sampling of tumor sites is thus becoming increasingly important. In this study, the utility and associated complications of mucosal cutting biopsy (MCB) for gastric SMTs were investigated. Methods. This was a case series study. The subjects were patients aged ≥20 years old in whom an SMT was seen on esophagogastroduodenography and who underwent MCB between January 2012 and December 2016. Patient information, endoscopy findings, gastric SMT size, pathological diagnosis, and other information were gathered from medical records. The SMT size was the maximum diameter that could be visualized on EUS. The pathological diagnosis was made with hematoxylin-eosin staining, with immunostaining added to diagnose GIST. The endpoint was the histopathological diagnostic yield. Risk assessment using the Miettinen classification and modified Fletcher classification was also done for GISTs treated with surgery. Results. The mean tumor diameter was 15.4 mm. The tumor diameter was ≥20 mm in seven patients and <20 mm in 23 patients. The tissue-acquiring rate was 93.3%. A histological diagnosis could not be made in two patients. The only complication was that bleeding required endoscopic hemostasis during the procedure in one patient, but no subsequent bleeding or no postoperative bleeding was seen. Conclusions. MCB is an appropriate and safe procedure in the diagnosis of gastric SMTs. Many hospitals will be able to perform MCB if they have the environment, including skills and equipment, to perform endoscopic submucosal dissection.

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Section: Discussionmentioning

confidence: 99%

“…However, there are no past reports of subsequent bleeding, and we find that biopsy procedure including MCB which exposes mucosa can be performed safely. [8, 22–24].…”

Section: Discussionmentioning

confidence: 99%

Examine the Availability and Safety of Mucosal Cutting Biopsy Technique for Diagnosis of Gastric Submucosal Tumor

Mizukami

Matsunari

Ogawa

et al. 2019

Gastroenterology Research and Practice

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“…10 EUS-FNA/B showed a shorter procedure time and more successful diagnosis for the larger SETs ( ≥ 20 mm) as compared with unroofing biopsy. 10 Although majority of previous studies were small case series, the overall diagnostic yield of the mucosal incision-assisted biopsy for SETs was reported as 89%. 6 The diagnostic yield for smaller SETs ( < 20 mm) was higher than EUS-FNA/B.…”

mentioning

confidence: 86%

“…Several similar mucosal incision-assisted biopsy techniques for gastric SETs such as the unroofing technique or single-incision needle-knife biopsy have been previously reported [ 6 - 9 ]. A prospective comparative study of EUS-FNA/B and unroofing biopsy in Korea reported no significant difference in the diagnostic yield between the two methods [ 10 ]. EUS-FNA/B showed a shorter procedure time and more successful diagnosis for the larger SETs (≥20 mm) as compared with unroofing biopsy [ 10 ].…”

mentioning

confidence: 99%

“…A prospective comparative study of EUS-FNA/B and unroofing biopsy in Korea reported no significant difference in the diagnostic yield between the two methods [ 10 ]. EUS-FNA/B showed a shorter procedure time and more successful diagnosis for the larger SETs (≥20 mm) as compared with unroofing biopsy [ 10 ]. Although majority of previous studies were small case series, the overall diagnostic yield of the mucosal incision-assisted biopsy for SETs was reported as 89% [ 6 ].…”

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confidence: 99%

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Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor

Choi

Hwang

2020

Clin Endosc

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Gastric subepithelial tumor (SET) develops beneath the mucosa or at the extraluminal compression by an intra-abdominal organ. 1 However, majority of gastric SETs are asymptomatic, measuring < 10 mm at the time of diagnosis. Therefore, deciding which gastric SETs require additional management remains difficult. Its basic assessment should be performed during the initial endoscopic examination where the SET is first identified. Several endoscopic findings such as the presence of a pillow/cushion sign, certain surface colors (yellowish for lipoma, transparent for cystic lesions, or bluish for vessel structures), or umbilication (suggestive of an ectopic pancreas) are biomarkers indicating a benign lesion. For gastric SETs with these benign endoscopic features, resection is generally unnecessary. 1 However, determining whether a SET is truly benign or has malignant potential such as gastrointestinal stromal tumor, lymphoma, neuroendocrine tumor, metastatic carcinoma, or adenocarcinoma is often difficult; thus, a definitive COMMENTARY

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A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images

Zhang

Gong

et al. 2023

J Applied Clin Med Phys

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Background Endoscopic ultrasonography (EUS) is recommended as the best tool for evaluating gastric subepithelial lesions (SELs); nonetheless, it has difficulty distinguishing gastrointestinal stromal tumors (GISTs) from leiomyomas and schwannomas. GISTs have malignant potential, whereas leiomyomas and schwannomas are considered benign. Purpose This study aimed to establish a combined radiomic model based on EUS images for distinguishing GISTs from leiomyomas and schwannomas in the stomach. Methods EUS images of pathologically confirmed GISTs, leiomyomas, and schwannomas were collected from five centers. Gastric SELs were divided into training and testing datasets based on random split‐sample method (7:3). Radiomic features were extracted from the tumor and muscularis propria regions. Principal component analysis, least absolute shrinkage, and selection operator were used for feature selection. Support vector machine was used to construct radiomic models. Two radiomic models were built: the conventional radiomic model included tumor features alone, whereas the combined radiomic model incorporated features from the tumor and muscularis propria regions. Results A total of 3933 EUS images from 485 cases were included. For the differential diagnosis of GISTs from leiomyomas and schwannomas, the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve were 74.5%, 72.2%, 78.7%, and 0.754, respectively, for the EUS experts; 76.8%, 74.4%, 81.0%, and 0.830, respectively, for the conventional radiomic model; and 90.9%, 91.0%, 90.6%, and 0.953, respectively, for the combined radiomic model. For gastric SELs <20 mm, the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the combined radiomic model were 91.4%, 91.6%, 91.1%, and 0.960, respectively. Conclusions We developed and validated a combined radiomic model to distinguish gastric GISTs from leiomyomas and schwannomas. The combined radiomic model showed better diagnostic performance than the conventional radiomic model and could assist EUS experts in non‐invasively diagnosing gastric SELs, particularly gastric SELs <20 mm.

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Prospective comparative study of endoscopic ultrasonography-guided fine-needle biopsy and unroofing biopsy

Cited by 12 publications

References 21 publications

Examine the Availability and Safety of Mucosal Cutting Biopsy Technique for Diagnosis of Gastric Submucosal Tumor

Examine the Availability and Safety of Mucosal Cutting Biopsy Technique for Diagnosis of Gastric Submucosal Tumor

Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor

A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images

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