Comparative Study for Diagnosis of Gastrointestinal Submucosal Lesions (GISML) Using Standard EUS-Fine Needle Aspiration (FNA) Versus EUS-Fine Needle Biopsy (FNB)
Patricia Jimenez, Abu-Suboh Abadia Monder, Margarita Alberola, Maria Carme Dinares, Carmela Iglesias, Joan Dot, Ana Benages, Santiago Ramon-y-Cajal, Natalia Tallada. Vall Hebron Hospital, Barcelona, Spain
Background: GISML are difficult to diagnose with EUS-FNA (sensitivity: 61-91%; specificity: 61-100%). The mesenchymal nature of most of these lesions makes it difficult to obtain reliable samples for cytological diagnosis with the standard FNA needle. A new EUS-guided biopsy needle with side fenestration (ProCore) was developed to enable EUS-FNB. Our aim was to compare results using the standard FNA 19G needle with those using the new FNB 19G device (ProCore).
Design: 20 consecutive patients who underwent EUS for evaluation of GISML were enrolled in a pilot study (June 2011-February 2012), using the standard 19G FNA needle and the new 19G FNB ProCore device. Previous radiological diagnoses were: 9 GISTs, 6 leiomyomas, 3 lipomas and 2 heterotopic pancreas. For every case, FNA and FNB with on-site-evaluation (OSE) were performed (1-3 passes each). For all cases, FNA smears and touch preps of FNB were obtained; cell blocks (CB) from FNA were available in 13/20 and tissue core (TC) from FNB in 20/20. IHC was performed when appropriate.
Results: Size of GISML was 25 ± 14 mm (mean ± SD). 5 were located in the oesophagus, 12 in gastric camera, 3 in duodenum. Cytological diagnosis with FNA was possible for 6/20 patients, and for 4/20 with FNB. Histological diagnosis was possible for 6/13 CB (FNA) and for 9/20 TC (FNB). Combining cytology and histology from both devices, a total of 10/20 patients were diagnosed: 6 GISTs, 3 leiomyomas, and 1 neuroendocrine tumor (NET), confirmed by IHC stains and surgical biopsy. Remaining cases (10/20) were reported “unsatisfactory” with both needles. FNA was diagnostic for 8/20 patients and FNB for 9/20. Both devices were coincident in diagnosis for 7/20 patients. Of the remaining 3, 2 were diagnosed as leiomyoma by FNB and 1 as NET by FNA. Previous radiological diagnoses by EUS were confirmed in 9/10 cases (6 GISTs, 3 leiomyomas); NET was diagnosed as GIST by previous EUS.
Conclusions: Although diagnosis remains difficult in GISML, mostly of mesenchymal origin, FNB seems to have a slight advantage over FNA. With the same caliber, FNB provides superior tissue samples. Our results show an overall diagnostic yield of 50% for the combined technique of EUS-FNA-FNB with specificity of 100%. 7/10 lesions that remain undiagnosed had a size between 10-18 mm that could explain the low sensitivity in this series. In our experience, improvement in results can be achieved through choosing the appropriate device, and combining cytology, histology and OSE.
Monday, March 4, 2013 1:00 PM
Poster Session II # 69, Monday Afternoon