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Endoscopic ultrasound-guided fine needle aspiration in submucosal lesion.

Moon JS - Clin Endosc (2012)

Bottom Line: A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose.Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion.All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose. Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion. For definite diagnosis, tissue acquisition from submucosal lesion is necessary, and many methods have been introduced for this purpose mainly by endoscopic ultrasonography, such as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), EUS-guided Trucut Biopsy (TCB), and EUS-guided fine needle biopsy (FNB). For EUS-FNA, adequate processing of specimen is important, and for proper diagnosis of EUS-FNA specimen, both cytologic and histologic examinations, including immunohistochemical stains, are important. All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion. We herein review the current hot topics on EUS-FNA for submucosal tumor, such as needles, on-site cytopathologists, immunohistochemical stains, EUS-TCB, EUS-FNB, Ki-67 labelling index, DOG1, and combining EUS-FNA and EUS-TCB.

No MeSH data available.


Related in: MedlinePlus

Microscopic findings. (A) Cellular epithelioid malignant gastrointestinal stromal tumor (GIST) with discohesive pattern of growth, nuclear anaplasia & pleomorphism (H&E stain, ×100). (B) Cellular epithelioid malignant GIST with frequent mitoses >5/50 high power fields (H&E stain, ×200). (C) Cytoplasmic membranous immunoreactivity for C-KIT (CD117) (Immunohistochemical stain, ×200). (D) Diffuse strong cytoplasmic immunoreactivity for CD34 (Immunohistochemical stain, ×40).
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Figure 5: Microscopic findings. (A) Cellular epithelioid malignant gastrointestinal stromal tumor (GIST) with discohesive pattern of growth, nuclear anaplasia & pleomorphism (H&E stain, ×100). (B) Cellular epithelioid malignant GIST with frequent mitoses >5/50 high power fields (H&E stain, ×200). (C) Cytoplasmic membranous immunoreactivity for C-KIT (CD117) (Immunohistochemical stain, ×200). (D) Diffuse strong cytoplasmic immunoreactivity for CD34 (Immunohistochemical stain, ×40).

Mentions: EUS-TCB that provides core tissue specimen can add significant information to EUS-FNA in selective patients. EUS-TCB was useful when immunohistochemical stain was needed in SMTs and lymphomas, for example, to confirm the primary or metastatic origin of mediastinal masses and necrotic tumors. Some difficulties, such as needle stiffness, misfire of the needle inside the lesion and procedural difficulty when the lesion was in the distal antrum, were reported using EUS-TCB.23 The accuracy of dual sampling (EUS-TCB with EUS-FNA) is superior to either technique alone. Sequential sampling (EUS-TCB with EUS-FNA rescue) has similar accuracy to that of dual sampling. EUS-TCB is superior to EUS-FNA in benign tumors or if immunostaining is required. In most instances, EUS-TCB does not offer additional benefit to EUS-FNA, but EUS-TCB should be considered when tissue architectural details and immunostaining are required (Figs. 1-5). Though the likelihood of obtaining adequate tissue was similar between EUS-FNA and EUS-TCB, accuracy for specific diagnosis was higher in EUS-TCB compared to EUS-FNA (68.4% vs. 5.3%, p<0.005).24


Endoscopic ultrasound-guided fine needle aspiration in submucosal lesion.

Moon JS - Clin Endosc (2012)

Microscopic findings. (A) Cellular epithelioid malignant gastrointestinal stromal tumor (GIST) with discohesive pattern of growth, nuclear anaplasia & pleomorphism (H&E stain, ×100). (B) Cellular epithelioid malignant GIST with frequent mitoses >5/50 high power fields (H&E stain, ×200). (C) Cytoplasmic membranous immunoreactivity for C-KIT (CD117) (Immunohistochemical stain, ×200). (D) Diffuse strong cytoplasmic immunoreactivity for CD34 (Immunohistochemical stain, ×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401613&req=5

Figure 5: Microscopic findings. (A) Cellular epithelioid malignant gastrointestinal stromal tumor (GIST) with discohesive pattern of growth, nuclear anaplasia & pleomorphism (H&E stain, ×100). (B) Cellular epithelioid malignant GIST with frequent mitoses >5/50 high power fields (H&E stain, ×200). (C) Cytoplasmic membranous immunoreactivity for C-KIT (CD117) (Immunohistochemical stain, ×200). (D) Diffuse strong cytoplasmic immunoreactivity for CD34 (Immunohistochemical stain, ×40).
Mentions: EUS-TCB that provides core tissue specimen can add significant information to EUS-FNA in selective patients. EUS-TCB was useful when immunohistochemical stain was needed in SMTs and lymphomas, for example, to confirm the primary or metastatic origin of mediastinal masses and necrotic tumors. Some difficulties, such as needle stiffness, misfire of the needle inside the lesion and procedural difficulty when the lesion was in the distal antrum, were reported using EUS-TCB.23 The accuracy of dual sampling (EUS-TCB with EUS-FNA) is superior to either technique alone. Sequential sampling (EUS-TCB with EUS-FNA rescue) has similar accuracy to that of dual sampling. EUS-TCB is superior to EUS-FNA in benign tumors or if immunostaining is required. In most instances, EUS-TCB does not offer additional benefit to EUS-FNA, but EUS-TCB should be considered when tissue architectural details and immunostaining are required (Figs. 1-5). Though the likelihood of obtaining adequate tissue was similar between EUS-FNA and EUS-TCB, accuracy for specific diagnosis was higher in EUS-TCB compared to EUS-FNA (68.4% vs. 5.3%, p<0.005).24

Bottom Line: A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose.Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion.All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose. Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion. For definite diagnosis, tissue acquisition from submucosal lesion is necessary, and many methods have been introduced for this purpose mainly by endoscopic ultrasonography, such as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), EUS-guided Trucut Biopsy (TCB), and EUS-guided fine needle biopsy (FNB). For EUS-FNA, adequate processing of specimen is important, and for proper diagnosis of EUS-FNA specimen, both cytologic and histologic examinations, including immunohistochemical stains, are important. All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion. We herein review the current hot topics on EUS-FNA for submucosal tumor, such as needles, on-site cytopathologists, immunohistochemical stains, EUS-TCB, EUS-FNB, Ki-67 labelling index, DOG1, and combining EUS-FNA and EUS-TCB.

No MeSH data available.


Related in: MedlinePlus