Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Gastric Subepithelial Tumors Located in the Cardia

• Published in: Digestive diseases and sciences 2020-02, Vol.65 (2), p.583-590
• Main Authors: Kim, Ga Hee, Ahn, Ji Yong, Gong, Chung Sik, Kim, Mimi, Na, Hee Kyong, Lee, Jeong Hoon, Jung, Kee Wook, Kim, Do Hoon, Choi, Kee Don, Song, Ho June, Lee, Gin Hyug, Jung, Hwoon-Yong
• Format: Article
• Language: English
• Subjects: Biochemistry; Biopsy; Endoscopic ultrasonography; Endoscopy; Fibroids; Gastroenterology; Gastrointestinal cancer; Health aspects; Hepatology; Medicine; Medicine & Public Health; Oncology; Original Article; Transplant Surgery; Tumors; Ultrasonic imaging
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05774-5

Background In cases of subepithelial tumors (SETs) located in the cardiac area, a preoperative histologic diagnosis might be helpful in determining the requirement of surgery. Aim To investigate the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in gastric SETs located in the cardia. Methods The data of 107 patients who underwent EUS-FNB, from 2012 to 2017, for tissue sampling of gastric SETs located in the cardia were collected. The clinicopathological data, EUS-related parameters, and surgical outcomes were retrospectively reviewed. Results The EUS-FNB results were diagnostic in 86.9% (93/107) and nondiagnostic in 13.1% (14/107) of the patients. Immunostaining of the FNB specimens led to the diagnosis of gastrointestinal stromal tumor (GIST) in 25 SETs (23.4%), leiomyoma in 62 SETs (57.9%), heterotopic pancreas in 3 SETs (2.8%), and schwannoma in 2 SETs (1.9%). In the multivariate analysis, patients with GISTs showed significantly more inhomogeneous echogenicity [odds ratio (OR), 8.867], more cystic foci (OR, 26.98), and older age (OR, 1.087). In 26 patients who underwent surgical resection, the agreement between EUS-FNB and surgical pathological findings was 100% with respect to the diagnosis of GISTs ( n  = 20) and leiomyoma ( n  = 7). Among these cases, the proportion of high-risk GISTs was 20.0% (4/20), and no leiomyosarcoma was detected. Conclusions Although a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.