Abstract
Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between 2016 and 2020 to evaluate EUS-guided fine-needle aspiration (EUS-FNA) biopsy outcomes in patients with negative endoscopic biopsy findings. A pathological GLP diagnosis was achieved by endoscopic biopsy in 40 patients (74.1%). EUS-FNA biopsy with a 22-gauge needle was performed in 13 of the remaining 14 patients, and GLP diagnosis was confirmed in 10 patients, with a median of three needle passes. The remaining four patients were laparoscopically diagnosed with GLP. The diagnostic ability of EUS-FNA biopsy for GLP was 76.9%, and EUS-FNA biopsy contributed to GLP diagnosis in 18.5% (10/54) of all cases. None of the 13 patients exhibited EUS-FNA biopsy-related adverse events. Univariable and multivariable analyses revealed an absence of superficial ulcerations as a predictor of false-negative endoscopic biopsy findings in patients with GLP. These results suggest EUS-FNA biopsy as a minimally invasive and safe alternative diagnostic modality for GLP in cases where conventional endoscopic biopsy fails to verify malignancy, although prospective studies with larger cohorts are warranted to confirm these findings.
Highlights
Gastric cancer (GC), the fifth most common cancer and the fourth leading cause of cancer-related deaths worldwide [1], exhibits morphological, biological, and clinical heterogeneity and is classified into several subtypes [2,3,4,5]
The present study aimed to investigate the value of endoscopic ultrasound (EUS) for Gastric linitis plastica (GLP) diagnosis by evaluating outcomes of EUS-guided fine-needle aspiration (EUS-fine-needle aspiration (FNA)) biopsy in patients with GLP and negative endoscopic biopsy findings
We evaluated the diagnostic value of EUS-FNA biopsy in GLP as an alternative modality in patients with inconclusive findings by standard endoscopic biopsy
Summary
Gastric cancer (GC), the fifth most common cancer and the fourth leading cause of cancer-related deaths worldwide [1], exhibits morphological, biological, and clinical heterogeneity and is classified into several subtypes [2,3,4,5]. Gastric linitis plastica (GLP) is a distinct subtype of GC characterized by segmental or diffuse thickening and rigidity of the gastric wall that results in a leather bottle-like appearance, as demonstrated by imaging studies [3,6,7]. Poorly cohesive cells and/or signet-ring cells that can diffusely infiltrate the gastric wall characterize GLP [6,7,8]. Terms such as diffuse infiltrating gastric cancer, scirrhous gastric cancer, and Borrmann type 4 gastric cancer have been indiscriminately used to define GLP. The recently developed pretherapeutic diagnostic scoring criteria for GLP—the Saint Louis linitis score, which exhibits high sensitivity and specificity [13]—is expected to aid in discriminating GLP from other GC subtypes
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