Yields and Utility of Endoscopic Ultrasonography-Guided 19-Gauge Trucut Biopsy versus 22-Gauge Fine Needle Aspiration for Diagnosing Gastric Subepithelial Tumors.
Author(s): Na HK, Lee JH, Park YS, Ahn JY, Choi KS, Kim do H, Choi KD, Song HJ, Lee GH, Jung HY, Kim JH
Publication: Clin Endosc, 2015, Vol. 48, Page 152-7
PubMed ID: 25844344 PubMed Review Paper? No
Purpose of Paper
This paper compared the rate of diagnosis in 19-gauge Trucut biopsy (TCB) and 22-gauge fine needle aspiration (FNA) specimens of gastric subepithelial tumors (SET) and investigated if endoscopic ultrasound (EUS) characteristics affected biopsy method choice.
Conclusion of Paper
Although specimens with irregular outer borders were more often biopsied by TCB, there were no differences in occurrence of other EUS characteristics or average number of passes required for choosing to sample specimens with TCB versus FNA. Overall diagnosis based on biopsy was possible in 64.1% of lesions. A diagnosis was achieved in significantly more TCB than FNA specimens and this was observed regardless of if the end diagnosis was gastrointestinal stromal tumors (GIST ) or non-GIST SET. Further, TCB specimens were significantly less likely to be characterized as non-diagnostic suspicious or non-diagnostic insufficient than FNA specimens.
Studies
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Study Purpose
This study compared the rate of diagnosis in 19-gauge TCB and 22-gauge FNA specimens of gastric SET and investigated if EUS characteristics affected biopsy method choice. EUS-guided biopsies were obtained from 152 patients with gastric SET by 22-G FNA (62 cases) or 19-G TCB (90 cases). The endosonagrapher chose the method of biopsy but the average tumor diameter was comparable between the two groups. Negative pressure was applied using a 10 mL syringe in the FNA procedure when necessary. TCB specimens were obtained by inserting the needle and withdrawing after firing the outer needle. Aspirates were smeared on slides, alcohol-fixed, and Papanicolaou-stained. Particles from FNA specimens and all TCB specimens were formalin-fixed for H&E staining. Pathology results were characterized as diagnostic (sufficient material to show cellular architecture or allow for diagnosis through IHC-staining), non-diagnostic suspicious (cellular material present but not sufficient to allow for diagnosis based on cellular structure or IHC staining), or as non-diagnostic insufficient (not enough material for diagnosis).
Summary of Findings:
Specimens with irregular outer borders were more often biopsied by TCB but there were no differences in the occurrence of heterogeneity of echo-textures, cystic foci, and hyperechoic spots in specimens sampled with the two different methods. An average of 3 biopsy passes per lesion were required, regardless of biopsy method. Overall diagnosis based on biopsy was possible in 64.1% (94 of 152) of lesions; however, diagnosis was possible in only 38.7% (24 of 62) of FNA specimens compared to 77.8% (70 of 90) of TCB specimens (P<0.001). FNA specimens were more likely to be characterized as non-diagnostic suspicious (22.6% versus 6.7%, P<0.05) or non-diagnostic insufficient (38.7% versus 15.5%, P<0.05). Further, the lower diagnosis rate in FNA than TCB specimens was observed both in cases diagnosed as gastrointestinal stromal tumors (GIST )(68.8% versus 90.9%, P=0.02) and non-GIST SET (14.3% versus 81.1%, P<0.01).
Biospecimens
Preservative Types
- Ethanol
- Formalin
Diagnoses:
- Neoplastic - Not specified
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology H-and-E microscopy Morphology Light microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Fine needle aspiration
Trucut biopsy
Biospecimen Acquisition Needle gauge 19 gauge
22 gauge