PERFORMANCE OF EUS-GUIDED TISSUE ACQUISITION IN SAMPLING OF GI SUBEPITHELIAL LESIONS

Aims:

The pathological diagnosis of gastrointestinal subepithelial lesions (SELs) is fundamental to guide management decisions. EUS guided tissue acquisition (EUS-TA) is crucial technique to reach the final pathological diagnosis. Different types of needles have been developed to perform fine needle biopsy (FNB) in order to overcome the limitations of standard fine-needle aspiration (FNA).

The aim of the study was to evaluate the performance of EUS-TA in the diagnosis of SELs.

Methods:

This is a retrospective, single-center study of consecutive patients with suspected SELs underwent EUS-TA.

Results:

A total of 82 patients were included in the study (41 female, 50%), with mean age of 64 years (SD 11.8). The average size of the lesions was 36.5 mm (SD 23.1); 61% of lesions were in stomach, 19.5% in the duodenum, 14.6% in the esophagus and cardias, and 4.9% in the rectosigmoidcolon.

In 61% of cases, an FNB needle was used. Overall, the most frequent caliber used was 22 G (74.4%).

Overall adequacy was reached in 75.6% of patients, without a statistically significant difference between FNA and FNB samples and between different needle calibers. However, a histological core was obtained more frequently with FNB than with FNA, 90% vs. 68,75%, respectively (p = 0.02). No immediate adverse events or technical difficulties were reported.

Fifty-one patients underwent surgical resection (62.2%), 38 of them had a diagnostic EUS-guided TA. In all of them, the pathological diagnosis obtained with EUS-TA was confirmed with the pathological analysis of surgical specimens.

Overall, the pathological diagnosis was GIST in 65 patients (79.3%), leiomyoma in 6 (7,3%), desmoid tumor in 1 (1.2%), schwannoma in 2 (2.4%), no adequacy and no surgery in 8 patients (9.8%).

Conclusions:

EUS-FNB for suspected SELs tumors had the same adequacy of FNA, with the same profile risk, but gave more histological core.