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Liyen Cartelle A, Holzwanger EA, Igbinedion S, Mahmood S, Rosenberg HJ, Berzin TM, Sawhney MS, Gabr M, Pleskow DK. Pyloric Gastric Adenoma: Endoscopic Detection, Removal, and Echoendosonographic Characterization. ACG Case Rep J 2023; 10:e01229. [PMID: 38130477 PMCID: PMC10735058 DOI: 10.14309/crj.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Pyloric gland adenomas (PGAs) are rare neoplasms found not only in the gastrointestinal tract but also in other extragastrointestinal organs. They have potential for malignant conversion, and early detection and removal is imperative to prevent invasive disease. PGAs prove difficult in management and surveillance given their rarity. However, increasing familiarity with histological appearance and use of advanced tools such as echoendosonography can bring greater understanding of their clinical history. We describe a unique case of a PGA detected within a hiatal hernia sac characterized with echoendosonography and highlight the need to develop surveillance protocols for these types of lesions.
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Affiliation(s)
- Anabel Liyen Cartelle
- Department of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Erik A. Holzwanger
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Samuel Igbinedion
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sultan Mahmood
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Harry J. Rosenberg
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mandeep S. Sawhney
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Moamen Gabr
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Douglas K. Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Kartashev AA, Yevtushenko EG, Charyshkin AL. Three cases of treatment of patients with colonic lipoma. GREKOV'S BULLETIN OF SURGERY 2022. [DOI: 10.24884/0042-4625-2022-181-2-82-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Three clinical cases of endoscopic and traditional surgical treatment of patients with a rare pathology – colon lipoma are presented. The diagnosis was established by colonoscopy and biopsy with histological examination. In one observation, the lipoma was removed endoscopically, in two cases, by open surgery. The postoperative period was uneventful, within 12–24 months, there was no recurrence of the disease. The presented cases show the possibility and effectiveness of both endoscopic and open surgical methods for the treatment of patients with colonic lipoma.
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Affiliation(s)
- A. A. Kartashev
- Ulyanovsk State University; Ulyanovsk Regional Clinical Center of specialized types of medical care named after the Honored Doctor of Russia E. M. Chuchkalov
| | - E. G. Yevtushenko
- Ulyanovsk Regional Clinical Center of specialized types of medical care named after the Honored Doctor of Russia E. M. Chuchkalov
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Lee JH, Cho CJ, Park YS, Ahn JY, Kim DH, Na HK, Choi KD, Song HJ, Lee GH, Jung HY. EUS-guided 22-gauge fine needle biopsy for the diagnosis of gastric subepithelial tumors larger than 2 cm. Scand J Gastroenterol 2016; 51:486-93. [PMID: 26061486 DOI: 10.3109/00365521.2015.1052095] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE EUS-guided fine needle biopsy (EUS-FNB) was introduced to obtain tissue cores. However, data on the efficacy of EUS-FNB for the diagnosis of gastric subepithelial tumors (SET) are limited. This study was aimed to determine the tissue acquisition and diagnostic yield of EUS-FNB using a novel 22-gauge FNB needle. MATERIAL AND METHODS Between May 2012 and February 2014, we retrieved data on 78 consecutive patients who underwent 22-gauge EUS-FNB for tissue sampling of gastric SET larger than 2 cm. Relevant tumor and EUS-related parameters were reviewed retrospectively. RESULTS The median tumor diameter was 2.8 cm and tumors were punctured successfully in 77 SET (98.7%). EUS-FNB was diagnostic in 81.8% of SET (63/77), by obtaining core biopsy tissue in 96.8% (61/63) and aspirates in 27.0% (17/63). FNB specimens permitted immunostaining for the diagnosis of gastrointestinal stromal tumors (GIST) in 30 SET (47.6%), 20 leiomyomas (31.7%), and 3 schwannomas (4.8%). Diagnoses could be made without immunostaining in 10 SET (15.9%). Tissue adequacy was optimal in 85.7% of FNB specimens by endosonographers' on-site visual evaluation. Endosonographers' evaluation of tissue adequacy was the only factor significantly associated with a higher diagnostic yield in univariate analysis. No adequate high-power fields for GIST risk stratification were available in FNB specimens. There was a single case of post-procedural bleeding (1.3%). CONCLUSION EUS-FNB using 22-gauge needle obtains a high yield for the diagnosis of gastric SET ≥2 cm, mostly via core tissue acquisition. Endosonographers should pay careful attention to the adequacy of FNB specimens.
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Affiliation(s)
- Jeong Hoon Lee
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Charles J Cho
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Young Soo Park
- b 2 Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Ji Yong Ahn
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Do Hoon Kim
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Hee Kyong Na
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Kee Don Choi
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Ho June Song
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Gin Hyug Lee
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
| | - Hwoon-Yong Jung
- a 1 Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center , Seoul, Korea
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Franco MC, Schulz RT, Maluf-Filho F. Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract? World J Gastrointest Endosc 2015; 7:1262-1267. [PMID: 26675266 PMCID: PMC4673388 DOI: 10.4253/wjge.v7.i18.1262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/28/2015] [Accepted: 11/11/2015] [Indexed: 02/05/2023] Open
Abstract
Subepithelial lesions (SELs) in the upper gastrointestinal (GI) tract are relatively frequent findings in patients undergoing an upper GI endoscopy. These tumors, which are located below the epithelium and out of reach of conventional biopsy forceps, may pose a diagnostic challenge for the gastroenterologist, especially when SELs are indeterminate after endoscopy and endoscopic ultrasound (EUS). The decision to proceed with further investigation should take into consideration the size, location in the GI tract, and EUS features of SELs. Gastrointestinal stromal tumor (GIST) is an example of an SEL that has a well-recognized malignant potential. Unfortunately, EUS is not able to absolutely differentiate GISTs from other benign hypoechoic lesions from the fourth layer, such as leiomyomas. Therefore, EUS-guided fine needle aspiration (EUS-FNA) is an important tool for correct diagnosis of SELs. However, small lesions (size < 2 cm) have a poor diagnostic yield with EUS-FNA. Moreover, studies with EUS-core biopsy needles did not report higher rates of histologic and diagnostic yields when compared with EUS-FNA. The limited diagnostic yield of EUS-FNA and EUS-core biopsies of SELs has led to the development of more invasive endoscopic techniques for tissue acquisition. There are initial studies showing good results for tissue biopsy or resection of SELs with endoscopic submucosal dissection, suck-ligate-unroof-biopsy, and submucosal tunneling endoscopic resection.
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Murad FM, Komanduri S, Abu Dayyeh BK, Chauhan SS, Enestvedt BK, Fujii-Lau LL, Konda V, Maple JT, Pannala R, Thosani NC, Banerjee S. Echoendoscopes. Gastrointest Endosc 2015; 82:189-202. [PMID: 26077457 DOI: 10.1016/j.gie.2015.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023]
Abstract
Advances in echoendoscopes and their processors have significantly expanded the role of EUS and its clinical applications.The diagnostic and therapeutic capabilities of EUS continue to evolve and improve. EUS has made a large impact on patient care but comes with significant startup and maintenance costs. As improved technology continues to enhance image resolution while decreasing the size of EUS processors, use of endosonography will become more widespread. EUS will continue to be a vital part of patient care and complement currently available cross-sectional imaging.
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Shapoval'jants SG, Goluhov GN, Plahov D, Fedorov ED, Mihalev AI, Mihaleva LM, Galkova K, Gorbachev EV, Sergeenko AE. [Diagnosis and immediate results of treatment of patients with non-epithelial tumors of upper gastrointestinal tract]. Khirurgiia (Mosk) 2015:35-42. [PMID: 26081185 DOI: 10.17116/hirurgia2015435-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We presented an experience of treatment of 225 patients with non-epithelial tumors of upper gastrointestinal tract. Complicated disease's course was observed in 24% of cases. Tactical approaches are discussed depending on localization, dimensions and nature of tumor growth. Also indications for minimally invasive operations are defined. It was operated 102 (45.3%) of above-mentioned patients. Conventional surgical interventions were performed in 49 (48.0%) cases, laparoscopic operations - in 11 (10.8%) observations, endoscopic techniques using flexible endoscope - in 42 (41.2%) patients. One hundred and twenty-three (54.7%) patients were under dynamic observation. Technical features of the performed operations are described in the article. Complications were diagnosed in 8 patients including intraoperative in 3 cases and postoperative in 5 cases. Postoperative mortality was 2.0% (2 of 102 died). Overall mortality was 1.3% (3 of 225 patients died). Gastrointestinal stromal tumor (38) and leiomyoma (29) were the most frequent findings among removed tumors.
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Affiliation(s)
- S G Shapoval'jants
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
| | - G N Goluhov
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
| | - Dots Plahov
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
| | - E D Fedorov
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
| | - A I Mihalev
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
| | | | - K Galkova
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
| | | | - A E Sergeenko
- Research and Education Center of Abdominal Surgery and Endoscopy of N.I. Pirogov Russian National Research Medical University
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Endoscopic resection of giant esophageal leiomyoma by tunelization technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2015. [DOI: 10.1016/j.rgmxen.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Hernández-Mondragón OV, Blancas-Valencia JM, Altamirano-Castañeda ML. Endoscopic resection of giant esophageal leiomyoma through the submucosal tunnel technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 80:167-8. [PMID: 25817698 DOI: 10.1016/j.rgmx.2014.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/30/2014] [Accepted: 11/06/2014] [Indexed: 12/21/2022]
Affiliation(s)
- O V Hernández-Mondragón
- Departamento de Endoscopia, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
| | - J M Blancas-Valencia
- Departamento de Endoscopia, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | - M L Altamirano-Castañeda
- Departamento de Endoscopia, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
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Çağlar E, Hatemi İ, Atasoy D, Şişman G, Şentürk H. Concordance of endoscopic ultrasonography-guided fine needle aspiration diagnosis with the final diagnosis in subepithelial lesions. Clin Endosc 2013; 46:379-383. [PMID: 23964335 PMCID: PMC3746143 DOI: 10.5946/ce.2013.46.4.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/10/2012] [Accepted: 01/16/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS In this study we aimed to determine the rate of concordance of endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) diagnosis with the final diagnosis obtained by surgery or endoscopic resection and follow-up in upper gastrointestinal subepithelial lesions. METHODS We retrospectively studied patients with subepithelial lesions who underwent EUS at our center from 2007 to 2011. RESULTS We had a final diagnosis in 67 patients (mean age±SD, 51.23±12.48 years; 23 [34.3%] female, 44 [65.6%] male). EUS-FNA was performed in all of the patients. On-site pathology was not performed. In nine of the patients, the obtained material which was obtained was insufficient. The cytologic examination was benign in 31 and malignant in 27 of the patients. Based on the final diagnosis, the EUS-FNA had a sensitivity of 96%, a specificity of 100%, and a diagnostic yield of 85%. CONCLUSIONS The diagnostic yield of EUS-FNA, in the absence of the on-site cytopathologist, is feasible for the diagnosis of subepithelial lesions of the upper gastrointestinal system.
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Affiliation(s)
- Erkan Çağlar
- Division of Gastroenterology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - İbrahim Hatemi
- Division of Gastroenterology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Deniz Atasoy
- Department of General Surgery, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Gürhan Şişman
- Division of Gastroenterology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Hakan Şentürk
- Division of Gastroenterology, University of Bezmi Alem Faculty of Medicine, Istanbul, Turkey
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Okten RS, Kacar S, Kucukay F, Sasmaz N, Cumhur T. Gastric subepithelial masses: evaluation of multidetector CT (multiplanar reconstruction and virtual gastroscopy) versus endoscopic ultrasonography. ACTA ACUST UNITED AC 2013; 37:519-30. [PMID: 21822967 DOI: 10.1007/s00261-011-9791-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the role of multidetector computed tomography (MDCT) with multiplanar reconstruction (MPR) and virtual gastroscopy (VG) for detection and differentiation of gastric subepithelial masses (SEMs) by comparison with endoscopic ultrasonography (EUS). METHODS Forty-one patients with a suspected SEM were evaluated using EUS and MDCT. MDCT findings were analyzed based on the consensus of two radiologists who were blinded to the EUS findings. The analysis of the CT features included the location, size, and contours of the tumor, the presence of central dimpling, as well as the growth pattern, enhancement pattern, and enhancement degree. The long diameter (LD) and the short diameter (SD) of each lesion were measured and the LD/SD ratios were calculated. EUS and MDCT results were compared with histopathology for the pathologically proven lesions. For the non-pathologically proven lesions, MDCT results were compared with EUS. RESULTS Among the 41 patients, 34 SEMs were detected using EUS. For the detection of SEMs with MDCT, a sensitivity of 85.3%, a specificity of 85.7%, a positive predictive value of 96.7%, and a negative predictive value of 54.5% were calculated. The overall accuracy of MDCT for detecting and classifying the SEMs was 85.3 and 78.8%, respectively. CONCLUSIONS MDCT with MPR and VG is a valuable method for the evaluation of SEMs. Specific MDCT criteria for various SEMs may be helpful in making an accurate diagnosis.
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Affiliation(s)
- Riza Sarper Okten
- Department of Radiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Sihhiye, Ankara, Turkey.
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Safety and efficacy of image-guided percutaneous biopsies in the diagnosis of gastrointestinal stromal tumors. Clin Imaging 2012; 36:19-23. [PMID: 22226438 DOI: 10.1016/j.clinimag.2011.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/30/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND After the invention of effective target agent therapy for gastrointestinal stromal tumors (GISTs), percutaneous biopsies may be indicated for unresectable diseases or before neoadjuvant chemotherapy. The purpose of this study was to evaluate the safety and efficacy of percutaneous biopsies for GISTs. MATERIAL AND METHODS Fifty-eight procedures of transluminal biopsies or image-guided percutaneous biopsies in 49 patients at our Institution from 1999 to 2010 were retrospectively reviewed. RESULT Twenty-three transluminal biopsies, 20 ultrasonography-guided biopsies, and 15 CT-guided biopsies were performed. Failure rate was higher in the group of transluminal biopsies (17%). There is no major procedure-related complication in patients who underwent percutaneous biopsy. However, life-threatening bleeding after transluminal biopsies happened in two patients. CONCLUSION Image-guided percutaneous biopsy is a safe and efficient alternative tool for the diagnosis of patients with GISTs.
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Endosonographic evaluation of patients with suspected extraluminal compression or subepithelial lesions during upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol 2011; 23:586-92. [PMID: 21654261 DOI: 10.1097/meg.0b013e3283461045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the endosonographic ultrasound (EUS) findings of patients with suspected extraluminal compression or subepithelial intramural lesions observed during upper gastrointestinal endoscopy. METHODS EUS findings were grouped as follows; compression by an extramural pathologic lesion, compression by an adjacent vascular structure, compression by adjacent organs, subepithelial intramural lesion, and normal EUS. RESULTS The data of 211 patients referred to the EUS unit between February 2004 and January 2010 for further evaluation of suspected extraluminal compression or subepithelial intramural lesions after upper gastrointestinal endoscopy were retrospectively analyzed. Mean age of the patients was 51.0±15.2 years, 124 (58.9%) of which were female. EUS examination was normal in 48 (22.7%) patients. EUS confirmed the presence of a pathological finding in the esophagus in 38 (92.6%) out of 41 patients when compared with abnormal findings in 122 (73.4%) of 166 patients who were evaluated for suspected lesions of the stomach (P=0.009). Suspected extraluminal compression of the esophagus (n=41) was due to a vascular structure in 17 (41.4% ) patients, an adjacent organ in four (9.7%) patients, an extramural pathological lesion in two (4.9%) patients, and a subepithelial intramural lesions in 15 (36.6%) patients, whereas in three patients (7.4%) EUS findings were normal. Of the 166 patients referred for evaluation of gastric lesions EUS findings were normal in 44 (26.5%) patients, whereas compression due to an adjacent organ was observed in 66 (39.7%) patients followed by compression by an adjacent vascular structure in 34 (20.4%) patients. An extramural pathologic lesion was discovered in 14 (8.6%) patients, whereas suspected compression was due to a subepithelial intramural lesion in eight (4.8%) patients. CONCLUSION Accurate diagnosis of suspected extraluminal compression or subepithelial intramural lesions, particularly in the stomach, requires meticulous evaluation. EUS provides an invasive but effective option. In one-third of cases, suspected extraluminal compression of the esophagus is actually due to a subepithelial intramural lesion.
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Nguyen VX, Nguyen CC, Li B, Das A. Digital image analysis is a useful adjunct to endoscopic ultrasonographic diagnosis of subepithelial lesions of the gastrointestinal tract. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1345-1351. [PMID: 20733191 DOI: 10.7863/jum.2010.29.9.1345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the role of digital image analysis in differentiating endoscopic ultrasonographic (EUS) features of potentially malignant gastrointestinal subepithelial lesions (SELs) from those of benign lesions. METHODS Forty-six patients with histopathologically confirmed gastrointestinal stromal tumors (GISTs), carcinoids, and lipomas who had undergone EUS evaluation were identified from our database. Representative regions of interest (ROIs) were selected from the EUS images, and features were extracted by texture analysis. On the basis of these features, an artificial neural network (ANN) was built, trained, and internally validated by unsupervised learning followed by supervised learning. Outcomes were the performance characteristics of the ANN. RESULTS A total of 106, 111, and 124 ROIs were selected from EUS images of 8, 10, and 28 patients with lipomas, carcinoids, and GISTs, respectively. For each ROI, 228 statistical parameters were extracted and later reduced to the 11 most informative features by principal component analysis. After training with 50% of the data, the remainder of the data were used to validate the ANN. The model was "good" in differentiating carcinoids and GISTs, with area under the receiver operating characteristic curve (AUC) values of 0.86 and 0.89, respectively. The model was "excellent" in identifying lipomas correctly, with an AUC of 0.92. CONCLUSIONS Digital image analysis of EUS images is a useful noninvasive adjunct to EUS evaluation of SELs.
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Affiliation(s)
- Vien X Nguyen
- Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W. Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 2010; 71:722-7. [PMID: 20171632 DOI: 10.1016/j.gie.2009.10.019] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 10/08/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS combined with endoluminal resection techniques is increasingly used to provide a definitive diagnosis of small gastric subepithelial lesions seen on standard upper endoscopy. OBJECTIVE To evaluate the accuracy of EUS in diagnosing small gastric subepithelial lesions by using histology as the criterion standard. DESIGN A retrospective study. SETTING Academic tertiary care center. PATIENTS A total of 22 patients (15 women, mean age 62.2 years) with an endoscopically resected gastric subepithelial lesion were included in this 3-year retrospective study. MAIN OUTCOME MEASUREMENTS The size, echogenicity, the layer of origin, and presumptive diagnosis were determined by EUS. The diagnostic accuracy of EUS was determined by using histology as the criterion standard. RESULTS The mean size of the 22 lesions was 13.6 mm (range 8-20 mm). An endoscopic cap band mucosectomy device was used to resect 16 (72.7%) lesions, whereas 6 (27.3%) were resected with a saline solution-assisted and snare technique. Using histology as a criterion standard, we found that the accuracy of the EUS diagnosis was 10 of 22 (45.5%). EUS alone had an accuracy rate of 30.8% and 66.7%, respectively, in the diagnosis of neoplastic and non-neoplastic lesions. LIMITATIONS A single-center, retrospective analysis. CONCLUSION EUS imaging had a low accuracy rate in the diagnosis of gastric subepithelial lesions, and endoscopic submucosal resection should be performed to provide a histologic diagnosis. Resection of small subepithelial lesions of 20 mm or less can be accomplished en bloc with an endoscopic cap band mucosectomy device.
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Affiliation(s)
- Cetin Karaca
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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Wronski M, Cebulski W, Slodkowski M, Krasnodebski IW. Gastrointestinal stromal tumors: ultrasonographic spectrum of the disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:941-948. [PMID: 19546335 DOI: 10.7863/jum.2009.28.7.941] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this series was to determine the spectrum of findings on gray scale trans-abdominal ultrasonography (TAUS) in pathologically proven cases of primary gastrointestinal stromal tumors (GISTs) and correlate them with gross morphologic and pathologic findings. METHODS The series included 18 patients with a primary GIST tumor detected on preoperative TAUS. The ultrasonographic findings were evaluated for features such as tumor size, shape, margin, echogenicity, and presence of fluid components, and the features were compared with morphologic and pathologic findings. RESULTS All of the primary GISTs were hypoechoic extraluminal masses with well-delineated margins. Eight GISTs were homogeneously solid masses, and 8 were heterogeneously solid masses that contained a large central area of lower echogenicity (n = 4) or multiple internal hypoechoic irregular spaces (n = 4) corresponding to necrosis and hemorrhage. Other tumors had a cystic appearance (n = 1) or showed a dual hyperechoic-hypoechoic echo structure (n = 1). Three tumors showed intratumoral gas due to fistulization into the bowel lumen, which appeared as hyperechoic foci or a linear hyperechoic area with acoustic shadowing. The heterogeneous tumors were significantly larger (P = .03) and had higher mitotic counts (P = .05). Gastrointestinal stromal tumors with high malignant potential tended to be large and showed intratumoral heterogenicity with areas of lower echogenicity. CONCLUSIONS Gastrointestinal stromal tumors showed varied patterns on TAUS. The ultrasonographic pattern depended on the tumor size and mitotic activity. Ultrasonographic features suggesting high malignant potential were size and internal heterogenicity with the presence of intratumoral hypoechoic areas.
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Affiliation(s)
- Marek Wronski
- Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland.
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Akahoshi K, Sumida Y, Matsui N, Oya M, Akinaga R, Kubokawa M, Motomura Y, Honda K, Watanabe M, Nagaie T. Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 2007; 13:2077-82. [PMID: 17465451 PMCID: PMC4319128 DOI: 10.3748/wjg.v13.i14.2077] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in the preoperative diagnosis of gastrointestinal stromal tumor (GIST).
METHODS: From September 2002 to June 2006, Fifty-three consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 31), or clinical follow-up (n = 22). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.
RESULTS: In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% (42/51). The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% (15/21), 86% (18/21), and 100% (9/9), respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100% (24/24), 80% (4/5), 96% (24/25), 100% (4/4), and 97% (28/29), respectively. No major complications were encountered.
CONCLUSION: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the prethera-peutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.
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Affiliation(s)
- Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio town, Iizuka 820-8505, Japan.
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Affiliation(s)
- Gerard A Isenberg
- Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106-5066, USA
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Arantes V, Logroño R, Faruqi S, Ahmed I, Waxman I, Bhutani MS. Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1141-1150. [PMID: 15328428 DOI: 10.7863/jum.2004.23.9.1141] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To study the yield of endoscopic ultrasonographically guided fine-needle aspiration cytologic examination in the diagnosis of submucosal masses. METHODS From 1999 to 2003, 10 patients underwent ultrasonographically guided fine-needle aspiration for the cytologic diagnosis of submucosal masses in our institution. The endoscopic ultrasonography records and the cytology database were consulted, and the reports were analyzed, as were slide material and the technical aspects related to these procedures. All procedures were performed under conscious sedation and cardiorespiratory monitoring on an outpatient basis. Ten patients (4 men and 6 women; mean age, 60.8 years) were studied. RESULTS Eight lesions were located in the stomach, and 2 were located in the esophagus, with a mean diameter of 3.3 cm. An experienced cytopathologist was present on-site during all procedures for assessment of adequacy and preliminary cytologic examination. Cytologic diagnoses were obtained in 8 cases as follows: 6 gastrointestinal stromal tumors, 1 organizing submucosal hematoma, and 1 low-grade mucosa-associated lymphoid tissue-associated lymphoma. Two cases consisted of scant gastric epithelium only and were considered nondiagnostic. The cytologic diagnoses guided further clinical treatment. CONCLUSIONS Ultrasonographically guided fine-needle aspiration with cytopathologic analysis has a high accuracy rate (80%) for diagnosing submucosal lesions. These findings potentially affect clinical decision making.
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Affiliation(s)
- Vitor Arantes
- Center for Endoscopic Ultrasound, Department of Medicine, University of Texas Medical Branch, Galveston 77555-0764, USA
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Huh CH, Bhutani MS, Farfán EB, Bolch WE. Individual variations in mucosa and total wall thickness in the stomach and rectum assessed via endoscopic ultrasound. Physiol Meas 2004; 24:N15-22. [PMID: 14658784 DOI: 10.1088/0967-3334/24/4/401] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endoscopic ultrasound is a unique tool to acquire in vivo data on alimentary tract wall thicknesses of sufficient resolution needed in radiation dosimetry studies. Through their different echo texture and intensity, five layers of differing echo patterns for superficial mucosa, deep mucosa, submucosa, muscularis externa and serosa/adventitia exist within the walls of organs composing the alimentary tract. In this study, retrospective image analyses of patient video data were made for ten examinations of the stomach and eight examinations of the rectum covering a range of patient ages. Thicknesses for stomach mucosa ranged from 1030 +/- 130 microm to 1640 +/- 80 microm (total stomach wall thicknesses from 2.80 +/- 0.12 to 4.23 +/- 0.03 mm). Measurements made for the rectal images revealed rectal mucosal thicknesses from 660 +/- 50 microm to 1130 +/- 250 microm (total rectal wall thicknesses from 2.28 +/- 0.05 to 3.55 +/- 0.43 mm). The mucosa accounted for approximately 32 +/- 7% and approximately 32 +/- 8% of the total thickness of the stomach and rectal wall, respectively. These values can thus be utilized to investigate uncertainties in alimentary tract dosimetry that are based upon fixed reference individual definitions of organ wall structure.
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Affiliation(s)
- C H Huh
- Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, FL 32611, USA
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Hunt GC, Rader AE, Faigel DO. A comparison of EUS features between CD-117 positive GI stromal tumors and CD-117 negative GI spindle cell tumors. Gastrointest Endosc 2003; 57:469-74. [PMID: 12665755 DOI: 10.1067/mge.2003.146] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND GI stromal tumors are spindle cell tumors that stain positive for immunohistochemical CD-117 (c-kit). Prognostic factors for malignancy include size (> or =4 cm), mitotic index (5 mitotic figures/50 high-powered fields), and ulcerated, cystic, or necrotic areas within the tumor. The purpose of this study was to compare these features in c-kit positive vs. c-kit negative tumors. METHODS All patients referred for EUS of submucosal lesions were identified, and histopathology, including immunohistochemical staining, was reviewed to determine all diagnoses of GI stromal tumors. Size, echo pattern, and presence of cystic spaces and ulceration were recorded as diagnosed by EUS. Histopathologic diagnoses were made by FNA or endoscopic submucosal-mucosal resection. If surgical resection followed, the surgical diagnosis, staining pattern, mitotic index, and presence of ulceration, necrosis, and nuclear atypia were recorded. RESULTS Forty patients (21 men, 19 women; 38 white, 2 African American; mean age 58 +/- 2.6 years) had 46 EUS procedures performed for evaluation of spindle cell tumors. Seventeen stained positive for c-kit (mean age, 59 +/- 3.6 years; range 19 to 80 years) and 12 negative (mean age, 57 +/- 3.8 years; range 31 to 76 years); 11 were not stained for c-kit (excluded from analysis). On EUS, 7 were ulcerated, 3 cystic, and 6 were larger than 4 cm. This group of findings was observed in 12 patients, 11 of whom had c-kit positive tumors (11/17 vs. 1/12; p = 0.006). Tumors positive for c-kit were larger (42.4 +/- 5.5 mm vs. 19.0 +/- 5.9 mm; p = 0.005). There were 13 c-kit positive tumors in the stomach, 2 in the duodenum, and 1 each in the esophagus and at the gastroesophageal junction. Of the 12 c-kit negative tumors, 8 were located in the esophagus and 1 at the gastroesophageal junction (9/12 vs. 2/17; p < 0.01). Surgical resection was performed on 13 patients, 12 of whom had c-kit positive tumors, and 3 of these 12 tumors had greater than 5 mitoses per 50 high-powered field. CONCLUSIONS If a GI stromal tumor is suspected, EUS-FNA with immunohistochemical staining should be performed for CD-117 (c-kit). C-kit tumors are more likely to have malignant features and should be resected or subjected to close clinical follow-up.
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Affiliation(s)
- Gordon C Hunt
- Department of Medicine, Oregon Health and Science University, Portland, USA
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