[408] Endoscopic Ultrasound (EUS) Guided Evaluation of Upper GI Subepithelial Masses: Comparison of Jumbo Forceps Biopsies (JB) and Touch Preparation (TP) with Fine Needle Aspiration (FNA)/Cell Block (CB).

Aparna Mahajan, Rajesh Keswani, Srinadh Komanduri, Xiaoqi Lin, Ritu Nayar. Northwestern University, Chicago, IL

Background: EUS-guided FNA is often performed for diagnosis of GI subepithelial masses. Alternatively, deep JB can be performed using JB forceps. JB is done via tunneling through the mucosa into the submucosa. A TP of JB allows immediate assessment of adequacy. The aim of our study was to compare the performance of EUS guided JB vs. EUS guided FNA in the diagnosis of subepithelial masses in the upper GI tract.
Design: We reviewed pathology reports and clinical information for 44 suspected upper GI subepithelial masses between 1/2006 and 6/2010. JB was performed with a Radial Jaw 4 forceps. FNA was performed with 19-25 gauge needles. On site evaluation (OSE) of adequacy was performed by a cytopathologist for all FNA and JB. Statistical differences of the two techniques were evaluated using Fisher's exact test.
Results: The location of masses was stomach (33), duodenum (8) and esophagus (3).

	No. of Cases	Adequate on "OSE"	CB	IHC on JB/CB	Definitive diagnosis
JB/TP	17	15 (88%)		15 (88%)	14 (82%)
FNA	14	10 (71%)	11 (80%)	6 (43%)	9 (64%)
JB/TP+FNA	13	11 (85%)	8 (62%)	10 (77%)	12 (92%)

There was no significant difference in the positive predictive value for OSE between the two techniques (FNA-only=90%, JB-only=87%, p=1). Three cases (JB=2, FNA=1) were non-diagnostic despite onsite "adequacy" due to misinterpretation of non lesional spindle cells. Final diagnostic adequacy was statistically higher using JB compared to FNA (90% vs. 67%, p = 0.03). The rate of diagnostic IHC using JB (88%) was greater than FNA/CB (43%, p = 0.018). There was no statistical difference in the proportion of definitive diagnosis obtained by JB+FNA/CB as compared to JB-only (p = 0.61).
Conclusions: JB with TP yields higher adequacy rates than FNA with CB for obtaining a definitive diagnosis by IHC. Concurrent FNA+JB during EUS did not provide any incremental diagnostic value compared to only JB with TP. Performance of OSE with TP for JB, provides the gastroenterologist with assurance that the “lesion” has been sampled and provides time and cost savings since concurrent FNA does not need to be performed. Availabilty of substantially more tissue by JB obviates the need for surgery if not indicated, and if surgery is performed IHC does not need to be repeated. For these reason, JB with TP has largely replaced FNA/CB for diagnosis of subepithelial masses by EUS in our clinical practice.
Category: Cytopathology

Tuesday, March 1, 2011 9:15 AM

Platform Session: Section F, Tuesday Morning