Endoscopy 2009; 41(4): 329-334
DOI: 10.1055/s-0029-1214447
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic yield and safety of endoscopic-ultrasound guided trucut biopsy in patients with gastric submucosal tumors: a prospective study

M.  Polkowski1 , 2 , W.  Gerke1 , 2 , D.  Jarosz1 , 2 , A.  Nasierowska-Guttmejer3 , P.  Rutkowski4 , Z.  I.  Nowecki4 , W.  Ruka4 , J.  Regula1 , 2 , E.  Butruk1 , 2
  • 1Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
  • 2Department of Gastroenterology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
  • 3Department of Pathology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
  • 4Department of Soft Tissue/Bone Sarcoma and Melanoma, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
Further Information

Publication History

submitted1 October 2008

accepted after revision18 December 2008

Publication Date:
01 April 2009 (online)

Background and study aims: Endoscopic-ultrasound-guided trucut needle biopsy (EUS-TCB) has not been adequately evaluated in patients with submucosal tumors (SMTs).

Patients and methods: This prospective, uncontrolled study involving 49 consecutive patients with hypoechoic gastric SMTs (≥ 20 mm) evaluated diagnostic yield and 30-day morbidity of EUS-TCB, factors related to the success of EUS-TCB, and agreement between EUS-TCB and the surgical pathology diagnosis. Seventy-three percent of tumors were gastrointestinal stromal tumors (GIST).

Results: Tumor tissue adequate for diagnosis was obtained by EUS-TCB in 31 patients (63 %; 95 %CI 49 % to 75 %). In the remaining cases, EUS-TCB provided no tissue (n = 11) or an insufficient amount (n = 7). Logistic regression analysis showed that tumor location on the lesser curvature of the stomach was the only independent predictor of obtaining diagnostic material [odds ratio (OR) 7.4; 95 %CI 1.9 to 28; P = 0.004]. The experience of the endosonographer, the size of the tumor, and the location of the tumor relative to the long axis of the stomach were not related to the success of the biopsy. Agreement between EUS-TCB and surgical pathology specimens in respect of the diagnosis and CD117 status was high (0.9, standard error 0.31; and 0.95, standard error 0.16, respectively); however, there was no correlation between the mitotic index as determined on EUS-TCB and that determined on the surgical pathology specimen (correlation coefficient, 0.08). There were two severe septic complications in 52 procedures (3.9 %; 95 %CI 0.3 % to 14 %).

Conclusions: The diagnostic yield of EUS-TCB in patients with gastric SMTs was moderate. Tissue samples were too small to reliably determine the mitotic index. Antibiotic prophylaxis should be considered because of possible septic complications.

References

M. Polkowski, MD 

Department of Gastroenterology and Hepatology
Medical Center for Postgraduate Education
M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology

Roentgena 5
02-781 Warsaw
Poland

Fax: +48-22-5463035

Email: m.polkowski@coi.waw.pl