EUS-guided FNA and FNB after on-site cytologic evaluation in gastric subepithelial tumors

Abstract

Objective

Adequate tissue acquisition for immunohistochemical (IHC) analysis is important in the differential diagnosis of subepithelial tumors (SETs). We compared the diagnostic yield from IHC analysis between endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and EUS-guided fine needle biopsy (EUS-FNB) after on-site cytologic evaluation for cellularity in gastric SETs.

Methods

In 22 patients with gastric SET, EUS-guided tissue sampling was performed on the same of SETs in a randomized sequence with EUS-FNA followed by EUS-FNB, or vice versa. After on-site cytologic evaluation for cellularity, the cytology and histology were analyzed.

Results

There was a significant difference in the median number of needle passes necessary to obtain adequate cellularity in the on-site cytologic evaluation (2.0 in EUS-FNA vs. 1.0 in EUS-FNB, p = 0.008). The proportion of adequate cellularity on the first pass was significantly greater in the FNB than in the FNA group (68.2% vs. 31.8%, p = 0.034). However, diagnosis by histologic analysis with IHC staining was established in 15 (68.2%) and 18 (81.8%) cases by EUS-FNA and EUS-FNB, respectively (p = 0.488).

Conclusion

EUS-FNB could decrease the number of needle passes necessary to obtain adequate cellularity and yield a greater proportion of adequate cellularity on the first pass compared to EUS-FNA in gastric SET. However, there was no significant difference in diagnostic yield with IHC staining between two procedures after on-site cytologic evaluation for adequate cellularity.

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