Skip to main content

Endoscopic ultrasound-guided Trucut biopsy of gastrointestinal mesenchymal tumor

Abstract

Background

Data on the utility of endoscopic ultrasound-guided Trucut biopsy (EUS-TCB) for suspected gastrointestinal mesenchymal tumor (GIMT) are limited. This study aimed to determine the diagnostic yield and complications from EUS-TCB for GIMT.

Methods

Consecutive patients with suspected upper gastrointestinal or rectal GIMT from the muscularis propria with a maximal diameter of 20 mm or more were enrolled in a prospective, single-center cohort. An EUS-TCB was performed when on-site fine-needle aspiration (FNA) cytology review of the lesion was deemed suboptimal. Gastrointestinal stromal tumor (GIST) and leiomyoma were defined by the presence or absence of positive immunochemistry (IC) for c-kit, respectively. All GIMTs with a nondiagnostic IC were considered as unspecified. The outcomes assessed included diagnostic pathologic and IC yield (when tested) and procedural complications.

Results

In this study, 38 patients (24 women; median age, 62 years) with suspected GIMT (median maximal diameter, 42 mm; range, 20–120 mm) in the esophagus (n = 6), stomach (n = 28), duodenum (n = 3), or rectum (n = 1) underwent EUS-TCB without complications. Final diagnoses included GIST for 20 patients, leiomyoma for 13 patients, unspecified GIMT for 3 patients, and unknown disorder for 2 patients. An EUS-FNA was performed for 33 (87%) of the 38 patients, a diagnostic final cytology for 25 (76%) of 33 patients, and an FNA-IC for 12 (50%) of 24 patients. The EUS-TCB (median, 3 passes; range, 1–8 passes) obtained a visible tissue specimen in 37 (97%) of the 38 patients, with a median overall maximal fragment length of 3.5 mm (range, 0–15 mm). The diagnostic final TCB histology and TCB-IC were obtained, respectively, in 79 and 97% of the samples tested.

Conclusions

In this cohort, EUS-TCB provided diagnostic histology and IC for 79 and 97% of the patients, respectively. For the initial biopsy of GIMT, EUS-TCB may be considered an acceptable alternative to EUS-FNA.

This is a preview of subscription content, access via your institution.

References

  1. Bucher P, Villiger P, Egger JF, Buhler LH, Morel P (2004) Management of gastrointestinal stromal tumors: from diagnosis to treatment. Swiss Med Wkly 134:145–153

    PubMed  Google Scholar 

  2. Stelow EB, Stanley MW, Mallery S, Lai R, Linzie BM, Bardales RH (2003) Endoscopic ultrasound-guided fine-needle aspiration findings of gastrointestinal leiomyomas and gastrointestinal stromal tumours. Am J Clin Pathol 119:703–708

    PubMed  Article  Google Scholar 

  3. Mazur MT, Clark HB (1983) Gastric stromal tumors: reappraisal of histogenesis. Am J Surg Pathol 7:507–519

    PubMed  Article  CAS  Google Scholar 

  4. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM (1998) Gastrointestinal pacemaker cell tumor (GIPACT): Gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 152:1259–1269

    PubMed  CAS  Google Scholar 

  5. Sircar K, Hewlett BR, Huizinga JD, Chorneyko K, Berezin I, Riddell RH (1999) Interstitial cells of Cajal as precursors of gastrointestinal stromal tumors. Am J Surg Pathol 23:377–389

    PubMed  Article  CAS  Google Scholar 

  6. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le Cesne A, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, van Glabbeke M, van Oosterom A, Demetri GD (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16:566–578

    PubMed  Article  Google Scholar 

  7. Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB (2007) Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 13:3301–3310

    PubMed  Google Scholar 

  8. Giovannini M, Seitz JF, Monges G, Perrier H, Rabbia I (1995) Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients. Endoscopy 27:171–177

    PubMed  Article  CAS  Google Scholar 

  9. Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM (1997) Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 112:1087–1095

    PubMed  Article  CAS  Google Scholar 

  10. Matsui M, Goto H, Niwa Y, Arisawa T, Hirooka Y, Hayakawa T (1998) Preliminary results of fine-needle aspiration biopsy histology in upper gastrointestinal submucosal tumors. Endoscopy 30:750–755

    PubMed  Article  CAS  Google Scholar 

  11. Williams DB, Sahai AV, Aabakken L, Penman ID, van Velse A, Webb J, Wilson M, Hoffman BJ, Hawes RH (1999) Endoscopic ultrasound-guided fine-needle aspiration biopsy: a large single-center experience. Gut 44:720–726

    PubMed  Article  CAS  Google Scholar 

  12. Gu M, Ghafari S, Nguyen PT, Lin F (2001) Cytologic diagnosis of gastrointestinal stromal tumors of the stomach by endoscopic ultrasound-guided fine-needle aspiration biopsy: cytomorphologic and immunohistochemical study of 12 cases. Diagnostic Cytopathol 25:343–350

    Article  CAS  Google Scholar 

  13. Ando N, Goto H, Niwa Y, Hirooka Y, Ohmiya N, Nagasaka T, Hayakawa T (2002) The diagnosis of GI stromal tumors with EUS-guided fine-needle aspiration with immunohistochemical analysis. Gastrointest Endosc 55:37–43

    PubMed  Article  Google Scholar 

  14. Arantes V, Logroño R, Faruqi S, Ahmed I, Waxman I, Bhutani MS (2004) Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract. J Ultrasound Med 23:1141–1150

    PubMed  Google Scholar 

  15. Elliott DD, Fanning CV, Caraway N (2006) The utility of fine-needle aspiration in the diagnosis of gastrointestinal stromal tumors: a cytomorphologic and immunohistochemical analysis with emphasis on malignant tumors. Cancer Cytopathol 108:49–55

    Google Scholar 

  16. Okubo K, Yamao K, Nakamura T, Tajika M, Sawaki A, Hara K, Kawai H, Yamamura Y, Mochizuki Y, Koshikawa T, Inada K (2004) Endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of gastrointestinal stromal tumors in the stomach. J Gastroenterol 39:747–753

    PubMed  Article  Google Scholar 

  17. Vander Noot MR III, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N, Syed S, Chhieng DC (2004) Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 102:157–163

    PubMed  Article  Google Scholar 

  18. Chen VK, Eloubeidi MA (2005) Endoscopic ultrasound-guided fine-needle aspiration of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management. Endoscopy 37:984–989

    PubMed  Article  CAS  Google Scholar 

  19. Akahoshi K, Sumida Y, Matsui N, Oya M, Akinaga R, Kubokawa M, Motomura Y, Honda K, Watanabe M, Nagaie T (2007) Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine-needle aspiration. World J Gastroenterol 13:2077–2082

    PubMed  Google Scholar 

  20. Chatzipantelis P, Salla C, Karoumpalis I, Apessou D, Sakellariou S, Doumani I, Papaliodi E, Konstantinou P (2008) Endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnosis of gastrointestinal stromal tumors of the stomach: a study of 17 cases. J Gastrointest Liver Dis 17:15–20

    Google Scholar 

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

    PubMed  Article  Google Scholar 

  22. Hoda KM, Rodríguez SA, Faigel DO (2009) EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc 69:1218–1223

    PubMed  Article  Google Scholar 

  23. Mekky MA, Yamao K, Sawaki A, Mizuno N, Hara K, Nafeh MA, Osman AM, Koshikawa T, Yatabe Y, Bhatia V (2010) Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 71:913–919

    PubMed  Article  Google Scholar 

  24. Storch I, Jorda M, Thurer R, Raez L, Rocha-Lima C, Vernon S, Ribeiro A (2006) Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc 64:505–511

    PubMed  Article  Google Scholar 

  25. Saftoiu A, Vilmann P, Skov BG, Georgescu CV (2007) Endoscopic ultrasound (EUS)-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: a prospective study. Scand J Gastroenterol 42:117–125

    PubMed  Article  Google Scholar 

  26. Kipp BR, Pereira TC, Souza PC, Gleeson FC, Levy MJ, Clayton AC (2009) Comparison of EUS-guided FNA and Trucut biopsy for diagnosing and staging abdominal and mediastinal neoplasms. Diagn Cytopathol 37:549–556

    PubMed  Article  Google Scholar 

  27. Thomas T, Kaye PV, Ragunath K, Aithal G (2009) Efficacy, safety, and predictive factors for a positive yield of EUS-guided Trucut biopsy: a large tertiary referral center experience. Am J Gastroenterol 104:584–590

    PubMed  Article  Google Scholar 

  28. Polkowski M, Gerke W, Jarosz D, Nasierowska-Guttmejer A, Rutkowski P, Nowecki ZI, Ruka W, Regula J, Butruk E (2009) Diagnostic yield and safety of endoscopic-ultrasound guided Trucut biopsy in patients with gastric submucosal tumors: a prospective study. Endoscopy 41:329–334

    PubMed  Article  CAS  Google Scholar 

  29. Gerke H, Rizk MK, Vanderheyden AD, Jensen CS (2010) Randomized study comparing endoscopic ultrasound-guided Trucut biopsy and fine-needle aspiration with high suction. Cytopathology 21:44–51

    PubMed  Article  CAS  Google Scholar 

  30. Fernández-Esparrach G, Sendino O, Solé M, Pellisé M, Colomo L, Pardo A, Martínez-Pallí G, Argüello L, Bordas JM, Llach J, Ginès A (2010) Endoscopic ultrasound-guided fine-needle aspiration and Trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy 42:292–299

    PubMed  Article  Google Scholar 

  31. Levy MJ, Jondal ML, Clain J, Wiersema MJ (2003) Preliminary experience with an EUS-guided Trucut biopsy needle compared with EUS-guided FNA. Gastrointest Endosc 57:101–106

    PubMed  Article  Google Scholar 

  32. Aithal GP, Anagnostopoulos GK, Tam W, Dean J, Zaitoun A, Kocjan G, Ragunath K, Pereira SP (2007) EUS-guided tissue sampling: comparison of “dual sampling” (Trucut biopsy plus FNA) with “sequential sampling” (Trucut biopsy and then FNA as required). Endoscopy 39:725–730

    PubMed  Article  CAS  Google Scholar 

  33. Yadav D, Levy MJ, Schwartz D, Jondal ML, Clain J, Wiersema MJ (2003) EUS-guided Trucut biopsy for diagnosis of an esophageal stromal tumor: case report. Gastrointest Endosc 58:457–460

    PubMed  Google Scholar 

  34. Al-Haddad M, DeWitt J (2009) EUS-guided sampling of suspected gastrointestinal stromal tumors: cells, cores, or a combination? (editorial). Gastrointest Endosc 69:1224–1227

    PubMed  Article  Google Scholar 

  35. Lee CK, Chung IK, Lee SH, Lee SH, Lee TH, Park SH, Kim HS, Kim SJ, Cho HD (2010) Endoscopic partial resection with the unroofing technique for reliable tissue diagnosis of upper GI subepithelial tumors originating from the muscularis propria on EUS (with video). Gastrointest Endosc 71:188–194

    PubMed  Article  Google Scholar 

  36. Sun S, Ge N, Wang S, Liu X, Lü Q (2009) EUS-assisted band ligation of small duodenal stromal tumors and follow-up by EUS. Gastrointest Endosc 69:492–496

    PubMed  Article  Google Scholar 

Download references

Disclosures

John DeWitt and Julia K. LeBlanc have received honoraria from Cook Endoscopy, Inc. Robert E. Emerson, Stuart Sherman, Mohammad Al-Haddad, Lee McHenry, Gregory A. Cote have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John DeWitt.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

DeWitt, J., Emerson, R.E., Sherman, S. et al. Endoscopic ultrasound-guided Trucut biopsy of gastrointestinal mesenchymal tumor. Surg Endosc 25, 2192–2202 (2011). https://doi.org/10.1007/s00464-010-1522-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1522-z

Keywords

  • Endoscopic ultrasound
  • Gastrointestinal stromal tumor
  • Leiomyoma
  • Submucosal mass
  • Tissue sampling
  • Trucut biopsy