Abstract
Endoscopic-ultrasound (EUS) guided Fine-needle Aspiration (FNA) has been used to reach a pathology diagnosis in submucosal tumors (SMTs) with a low diagnostic yield. Standard and reverse bevel technology needles acquire cytology and cell-block that provide a sample adequate for a suspicion diagnosis but mostly inadequate for immunohistochemistry that is necessary to reach a definitive diagnosis in this kind of lesions. Histology needles have demonstrated a high yield and obtain cores adequate for immunohistochemistry in pancreatic lesions To evaluate the quality and clinical impact of histology samples obtained with a needle designed to obtain core biopsy in SMTs. We included samples from SMTs obtained through EUS-guided FNA using the SharkCoreTM (Medtronic, Dublin) needle from March 2015 to November 2017. We recorded technical data for every pass including needle size, puncture route, easiness of puncture and presence of visible core. Samples were placed on a micro-philter, processed as biopsies, formalin fixed and paraffin embedded. Pathology evaluation included for every sample: diagnosis, presence of histologic core, recognizable architecture, degree of differentiation and immunohistochemical markers. A total 38 passes with a 22G needle were performed on 25 SMTs (average1.46 passes per lesion). A visible core that permitted full histologic study was obtained in 36 passes (36/38;94.7%) but it was representative of the expected lesion only in 35(35/36;97.2%). A final diagnosis considering all passes was obtained in the 24 lesions(24/25;93.75%). Immunohistochemistry was necessary to reach a complete final diagnosis in 20 SMTs (20/25;80%) including twelve GIST, six leiomyomas, one glomic tumor and one undifferentiated tumor. EUS-guided fine needle biopsy provides samples adequate for histologic diagnosis representing a reliable technique to diagnose submucosal tumors. Having a biopsy core that allows for imunohistochemical profiling was necessary to reach a final diagnosis in a significant number of cases.
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