Clin Endosc.  2017 Jul;50(4):372-378. 10.5946/ce.2016.083.

Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumors

• Tamura T
• Yamashita
• Ueda K
• Kawaji Y
• Itonaga M
• Murata SI
• Yamamoto K
• Yoshida T
• Maeda H
• Maekita T
• Iguchi M
• Tamai H
• Ichinose M
• Kato J

• KMID: 2389243
• DOI: http://doi.org/10.5946/ce.2016.083

Abstract

BACKGROUND/AIMS
Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone.
METHODS
Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison.
RESULTS
The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06).
CONCLUSIONS
ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.

Keyword

Endoscopic ultrasound-guided fine needle aspiration; Gastrointestinal stromal tumor; Endosonographer; On-site cytology

MeSH Terms

Biopsy, Fine-Needle*
Diagnosis*
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Gastrointestinal Stromal Tumors*
Humans
Needles

Figure

• 

  Fig. 1. Specimen processing for endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) by endosonographers. (A) A submucosal tumor (SMT) of the stomach is seen as a protuberant lesion (arrow) with an ulcer by upper endoscopy. (B) B-mode EUS images reveal a low echoic lesion (arrow). (C) The aspiration needle (arrow) punctures the mass. (D) The specimens are transferred to a watch glass. (E) The cytological slides processed from whitish specimens per puncture. (F) May–Giemsa staining using the Diff-Quik method detects spindle-shaped cells (arrows) (×400). (G) Papanicolaou staining for cytological smear shows spindle-shaped cells (×400). (H) Hematoxylin and eosin staining for histological examination shows spindle-shaped cells (×200). (I, J, K) Immunohistochemical staining with c-kit (I), CD34 (J), and S-100 (K). Positive staining is observed with c-kit and CD34, whereas S-100 staining is negative (×200).

• 

  Fig. 2. Sequence of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) procedure with and without rapid on-site evaluation (ROSE).

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