Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions

  • Seigo Nakatani (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Kosuke Okuwaki (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Masafumi Watanabe (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Hiroshi Imaizumi (Department of Gastroenterology, Japan Community Health Care Organization Sagamino Hospital) ;
  • Tomohisa Iwai (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Takaaki Matsumoto (Department of Gastroenterology, Isehara Kyodo Hospital) ;
  • Rikiya Hasegawa (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Hironori Masutani (Department of Gastroenterology, Japan Community Health Care Organization Sagamino Hospital) ;
  • Takahiro Kurosu (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Akihiro Tamaki (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Junro Ishizaki (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Ayana Ishizaki (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Mitsuhiro Kida (Department of Gastroenterology, Kitasato University School of Medicine) ;
  • Chika Kusano (Department of Gastroenterology, Kitasato University School of Medicine)
  • Received : 2022.10.18
  • Accepted : 2022.11.14
  • Published : 2024.01.30
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Abstract

Background/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). Methods: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA's diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. Results: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. Conclusions: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

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References

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