7232 Diagnosis of gastric submucosal tumors by endoscopic ultrasonography (eus); only image vs. eus-guided fine needle aspiration biopsy.

Abstract

Introduction:Endoscopic ultrasonography-guided fine needle aspiration biopsy (EUS-FNAB) for gastric submucosal tumors (SMTs) is controversial. Although it is generally believed that the EUS diagnosis of SMTs is reliable, and the rate obtained from histological samples from SMTs by EUS-FNAB is admittedly not so high, we are sometimes at a loss whether we should recommend a patient to undergo surgical resection or merely be observed. Therefore, we compared simple EUS diagnosis by experienced EUS doctors and results of EUS-FNAB. Subjects and methods: From March 1994 to May 1999 we performed EUS-FNAB in twenty-three patients with gastric SMT. All SMTs were over 3 cm. We gave five senior EUS doctors 2 EUS images of each SMT, and had them answer questionnaires regarding the diagnosis of SMT and treatment options. These doctors have experienced EUS for over five years. They judged the diagnosis of SMT and surgical resection or follow-up. Initially, we used a radial scanner GF-UM20 (Olympus Optical Co. Ltd.) for diagnosis. EUS-FNAB was performed using Pentax FG-32UA or FG-36UX convex array endosonography. Results: 1. Twenty-three patients with SMT were average 57.7 years old, 14 men and 9 women. SMTs were 14 leiomyomas, 4 leiomyosarcomas, 4 aberrant pancreases, and 1 ectopic gastric gland (mean size 33.4mm). 2. Simple EUS diagnosis was about 50% accurate by EUS senior doctors. 3. Diagnosis in 17 out of 23 SMTs was in accordance among experienced doctors („ 80%). Six of 17 SMTs were misdiagnosed. Of these 6 SMTs we obtained 4 correct diagnoses by EUS-FNAB. The six out-of-accordance cases included 3 aberrant pancreases. 4. Even when the doctors diagnosed leiomyoma, they recommended surgical resection because of a diameter over 50 mm and rapid growth in a short time. Conclusions: 1. FNA was useful for the relatively large solid tumor with cystic structure, for example, leiomyoma, leiomyosarcoma, and aberrant pancreas. 2. However, FNA diagnosis did not influence the choice of surgery or follow-up for tumors over 50 mm in diameter.