Clin Endosc.  2015 Mar;48(2):152-157. 10.5946/ce.2015.48.2.152.

Yields and Utility of Endoscopic Ultrasonography-Guided 19-Gauge Trucut Biopsy versus 22-Gauge Fine Needle Aspiration for Diagnosing Gastric Subepithelial Tumors

• Na HK
• Lee JH
• Park YS
• Ahn JY
• Choi KS
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Jung HY
• Kim JH

• KMID: 1801207
• DOI: http://doi.org/10.5946/ce.2015.48.2.152

Abstract

BACKGROUND/AIMS
To evaluate the yields and utility of 19-gauge (G) Trucut biopsy (TCB) versus 22 G fine needle aspiration (FNA) for diagnosing gastric subepithelial tumors (SETs).
METHODS
We retrieved data for 152 patients with a gastric SET larger than 2 cm who had undergone endoscopic ultrasonography (EUS)-guided 19 G TCB (n=90) or 22 G FNA (n=62). Relevant clinical, tumor-specific, and EUS procedural information was reviewed retrospectively.
RESULTS
A specific diagnosis was made for 76 gastrointestinal stromal tumors (GISTs) and 51 non-GIST SETs. The diagnostic yield of TCB was greater than that of FNA (77.8% vs. 38.7%, p<0.001). The percentage of non-diagnostic specimens (suspicious and insufficient) was significantly lower in the TCB group (6.7% and 15.5%, respectively) than in the FNA group (22.6% and 38.7%, respectively; both p<0.001). TCB accurately diagnosed 90.9% of GISTs and 81.1% of non-GIST SETs, whereas FNA accurately diagnosed 68.8% of GISTs and 14.3% of non-GIST SETs. There were nine technical failures with TCB, and the rate of adverse events did not differ between the groups (TCB vs. FNA, 3.3% vs. 8.1%; p=0.27).
CONCLUSIONS
Nineteen-gauge TCB is safe and highly valuable for diagnosing gastric SETs larger than 2 cm if technical failure can be avoided.

Keyword

Endosonography; Subepithelial tumors; Biopsy, large-core needle; Endoscopic ultrasound-guided fine needle aspiration; Stomach

MeSH Terms

Biopsy*
Biopsy, Fine-Needle*
Biopsy, Large-Core Needle
Diagnosis
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Gastrointestinal Stromal Tumors
Humans
Retrospective Studies
Stomach

Figure

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  Fig. 1 Study patients. EUS, endoscopic ultrasonography; SET, subepithelial tumor; G, gauge; FNA, fine needle aspiration; TCB, Trucut biopsy; GIST, gastrointestinal stromal tumor.

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  Fig. 2 Diagnostic yields of 22-gauge (G) fine needle aspiration (FNA) and 19 G Trucut biopsy (TCB).

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  Fig. 3 Diagnostic yields of gastrointestinal stromal tumors (GISTs) and non-GIST gastric subepithelial tumors. SET, subepithelial tumors; G, gauge; FNA, fine needle aspiration; TCB, Trucut biopsy.

Reference

1. Ando N, Goto H, Niwa Y, et al. The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc. 2002; 55:37–43. PMID: 11756912.

2. Wiech T, Walch A, Werner M. Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy. 2005; 37:630–634. PMID: 16010607.

3. Papanikolaou IS, Triantafyllou K, Kourikou A, Rösch T. Endoscopic ultrasonography for gastric submucosal lesions. World J Gastrointest Endosc. 2011; 3:86–94. PMID: 21772939.

4. Erickson RA. EUS-guided FNA. Gastrointest Endosc. 2004; 60:267–279. PMID: 15278063.

5. Mortensen MB, Pless T, Durup J, Ainsworth AP, Plagborg GJ, Hovendal C. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy. 2001; 33:478–483. PMID: 11437039.

6. Chang KJ, Katz KD, Durbin TE, et al. Endoscopic ultrasound-guided fine-needle aspiration. Gastrointest Endosc. 1994; 40:694–699. PMID: 7859967.

7. Sepe PS, Moparty B, Pitman MB, Saltzman JR, Brugge WR. EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc. 2009; 70:254–261. PMID: 19482280.

8. Varadarajulu S, Fraig M, Schmulewitz N, et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy. 2004; 36:397–401. PMID: 15100946.

9. Rader AE, Avery A, Wait CL, McGreevey LS, Faigel D, Heinrich MC. Fine-needle aspiration biopsy diagnosis of gastrointestinal stromal tumors using morphology, immunocytochemistry, and mutational analysis of c-kit. Cancer. 2001; 93:269–275. PMID: 11507701.

10. Ramesh J, Varadarajulu S. How can we get the best results with endoscopic ultrasound-guided fine needle aspiration? Clin Endosc. 2012; 45:132–137. PMID: 22866253.

11. Karadsheh Z, Al-Haddad M. Endoscopic ultrasound guided fine needle tissue acquisition: where we stand in 2013? World J Gastroenterol. 2014; 20:2176–2185. PMID: 24605016.

12. Wiersema MJ, Levy MJ, Harewood GC, Vazquez-Sequeiros E, Jondal ML, Wiersema LM. Initial experience with EUS-guided trucut needle biopsies of perigastric organs. Gastrointest Endosc. 2002; 56:275–278. PMID: 12145612.

13. Fernández-Esparrach G, Sendino O, Solé M, et al. Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy. 2010; 42:292–299. PMID: 20354939.

14. Hoda KM, Rodriguez SA, Faigel DO. EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc. 2009; 69:1218–1223. PMID: 19394006.

15. Polkowski M, Gerke W, Jarosz D, et al. Diagnostic yield and safety of endoscopic ultrasound-guided trucut [corrected] biopsy in patients with gastric submucosal tumors: a prospective study. Endoscopy. 2009; 41:329–334. PMID: 19340737.

16. Polkowski M, Larghi A, Weynand B, et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy. 2012; 44:190–206. PMID: 22180307.

17. Fazel A, Draganov P. Interventional endoscopic ultrasound in pancreatic disease. Curr Gastroenterol Rep. 2004; 6:104–110. PMID: 15191687.

18. Dumonceau JM, Polkowski M, Larghi A, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2011; 43:897–912. PMID: 21842456.

19. Moon JS. Endoscopic ultrasound-guided fine needle aspiration in submucosal lesion. Clin Endosc. 2012; 45:117–123. PMID: 22866250.

20. Lee JH, Choi KD, Kim MY, et al. Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors >/= 2 cm in diameter. Gastrointest Endosc. 2011; 74:1010–1018. PMID: 21889136.

21. Song HJ, Park YS, Seo DW, et al. Diagnosis of mediastinal tuberculosis by using EUS-guided needle sampling in a geographic region with an intermediate tuberculosis burden. Gastrointest Endosc. 2010; 71:1307–1313. PMID: 20417504.

22. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002; 33:459–465. PMID: 12094370.

23. Dumonceau JM, Koessler T, van Hooft JE, Fockens P. Endoscopic ultrasonography-guided fine needle aspiration: relatively low sensitivity in the endosonographer population. World J Gastroenterol. 2012; 18:2357–2363. PMID: 22654426.

24. Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc. 2000; 51:184–190. PMID: 10650262.

25. Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration. A cytopathologist's perspective. Am J Clin Pathol. 2003; 120:351–367. PMID: 14502798.

26. Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy. 2005; 37:635–645. PMID: 16010608.

27. Mekky MA, Yamao K, Sawaki A, et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc. 2010; 71:913–919. PMID: 20226456.

28. Thomas T, Kaye PV, Ragunath K, Aithal G. Efficacy, safety, and predictive factors for a positive yield of EUS-guided Trucut biopsy: a large tertiary referral center experience. Am J Gastroenterol. 2009; 104:584–591. PMID: 19262518.

29. Storch I, Jorda M, Thurer R, et al. Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc. 2006; 64:505–511. PMID: 16996340.

30. Iglesias-Garcia J, Poley JW, Larghi A, et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc. 2011; 73:1189–1196. PMID: 21420083.

31. Bang JY, Varadarajulu S. Procore and flexible 19 gauge needle can replace trucut biopsy needle? Clin Endosc. 2013; 46:503–505. PMID: 24143312.

32. Kim GH, Cho YK, Kim EY, et al. Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand J Gastroenterol. 2014; 49:347–354. PMID: 24325591.

33. Lee YN, Moon JH, Kim HK, et al. Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study. Endoscopy. 2014; 46:1056–1062. PMID: 25098611.