Original article
Clinical endoscopy
EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield

https://doi.org/10.1016/j.gie.2008.11.038Get rights and content

Background

EUS-guided FNA has been well documented to aid in the diagnosis of subepithelial lesions by providing cytologic material. Studies to date evaluating the sensitivity of EUS-FNA for the diagnosis of GI stromal cell tumors (GIST) have been small, and few have relied on surgical histologic diagnosis as the reference standard.

Objective

Our purpose was to determine the diagnostic yield and sensitivity of EUS-FNA for the diagnosis of GIST and to identify EUS features of GIST that are predictive of the ability to obtain adequate tissue by EUS-FNA.

Design

All patients with histologically confirmed, c-kit–positive GIST who underwent EUS-FNA from 1998 to 2006 were reviewed. EUS images were examined for mass size, shape, location, wall layer, heterogeneity, echogenicity, cystic spaces, lobulation, ulceration, and central umbilication. Needle gauge, number of needle passes, and presence of a cytologist during the EUS-FNA were recorded.

Results

A total of 37 patients (29 with diagnostic FNA cytology; 8 with nondiagnostic cytology) met the inclusion criteria. The diagnostic yield and sensitivity of EUS-FNA cytology for the diagnosis of GIST was 78.4% (29/37). The sensitivity was 84.4% (27/32) for GISTs located in the stomach, but poor for lesions located in the duodenum because none of these tumors yielded diagnostic cytology (n = 3). An increase in size up to 10 cm, round/oval shape, and identification of the origin of GIST within a specific sonographic wall layer were statistically significant in their ability to predict adequate tissue yield.

Conclusions

The sensitivity of EUS-FNA cytology for the diagnosis of GIST is 78.4% and is influenced by size, location, shape, and layer of origin.

Section snippets

Methods

In this retrospective study, the combined Massachusetts General Hospital (MGH) and Brigham and Women's Hospital (BWH) pathology database was searched for all patients presenting between January 1998 and May 2006 with surgically resected, histologically confirmed, c-kit–positive GISTs. Computerized medical records were reviewed for all patients to determine those who also underwent EUS-guided FNA before surgical removal. Those patients with primary GISTs located in the esophagus, stomach, small

Results

Review of the pathology database yielded 460 patients with surgically resected, histologically confirmed, c-kit–positive GISTs. Of these, 37 patients met inclusion criteria. GISTs were located in the stomach in 32 patients, the duodenum in 3 patients, the esophagus in 1 patient, and the rectum in 1 patient. There were 29 patients with diagnostic FNA cytologic findings (group A), and 8 patients with nondiagnostic cytologic findings (group B). A total of 44.8% (13/29) of patients in group A were

Discussion

GISTs are the most commonly identified intramural, subepithelial mass in the upper GI tract, accounting for approximately 5000 to 6000 new cases each year.6 These masses are frequently found on endoscopy performed for other reasons, but patients may also present with abdominal pain, bleeding, or symptoms of mass effect. Approximately 20% to 25% of gastric and 40% to 50% of small-intestinal GISTs are clinically malignant,3 but it is well recognized that all GISTs have some degree of malignant

Acknowledgments

We thank Shiva Gautam, PhD, for his help in reviewing the statistics in this article.

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    DISCLOSURE: The following author disclosed financial relationships relevant to this publication: W. Brugge received an educational grant from Pentax Corporation. All other authors disclosed no financial relationships relevant to this publication.

    Presented at Digestive Diseases Week, May 21, 2007, Washington, DC (Gastrointest Endosc 2007;65:AB205).

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