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Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Gastric Subepithelial Tumors Located in the Cardia

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Abstract

Background

In cases of subepithelial tumors (SETs) located in the cardiac area, a preoperative histologic diagnosis might be helpful in determining the requirement of surgery.

Aim

To investigate the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in gastric SETs located in the cardia.

Methods

The data of 107 patients who underwent EUS-FNB, from 2012 to 2017, for tissue sampling of gastric SETs located in the cardia were collected. The clinicopathological data, EUS-related parameters, and surgical outcomes were retrospectively reviewed.

Results

The EUS-FNB results were diagnostic in 86.9% (93/107) and nondiagnostic in 13.1% (14/107) of the patients. Immunostaining of the FNB specimens led to the diagnosis of gastrointestinal stromal tumor (GIST) in 25 SETs (23.4%), leiomyoma in 62 SETs (57.9%), heterotopic pancreas in 3 SETs (2.8%), and schwannoma in 2 SETs (1.9%). In the multivariate analysis, patients with GISTs showed significantly more inhomogeneous echogenicity [odds ratio (OR), 8.867], more cystic foci (OR, 26.98), and older age (OR, 1.087). In 26 patients who underwent surgical resection, the agreement between EUS-FNB and surgical pathological findings was 100% with respect to the diagnosis of GISTs (n = 20) and leiomyoma (n = 7). Among these cases, the proportion of high-risk GISTs was 20.0% (4/20), and no leiomyosarcoma was detected.

Conclusions

Although a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.

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Funding

This work was supported by the Korean College of Helicobacter and an Upper Gastrointestinal Research Foundation grant.

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Ga Hee Kim, Ji Yong Ahn, Hee Kyong Na, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Hwoon-Yong Jung

  2. Department of Gastric Surgery, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Chung Sik Gong

  3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Mimi Kim

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  1. Ga Hee Kim
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Contributions

Ga Hee Kim and Ji Yong Ahn designed the study; Kee Don Choi analyzed the raw data and performed statistical analyses; Mimi Kim, Hee Kyong Na, Do Hoon Kim, Jeong Hoon Lee, and Hwoon-Yong Jung contributed to data collection; Kee Wook Jung, Ho June Song, and Gin Hyug Lee interpreted the data; Chung Sik Gong and Do Hoon Kim contributed to data interpretation and critical revision of the manuscript; Ga Hee Kim drafted the manuscript and prepared it for submission; All authors revised the manuscript critically for important intellectual content and approved the version to be published.

Corresponding author

Correspondence to Ji Yong Ahn.

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All authors declare that they have no conflict of interest.

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All procedures performed in in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kim, G.H., Ahn, J.Y., Gong, C.S. et al. Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Gastric Subepithelial Tumors Located in the Cardia. Dig Dis Sci 65, 583–590 (2020). https://doi.org/10.1007/s10620-019-05774-5

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