Clinical Endoscopy

Focused Review Series: Recent Update of Endoscopic Ultrasonography in Gastrointestinal Subepithelial Tumors

Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors: Takashi Tamura, Masayuki Kitano; Clin Endosc 2019;52(4):306-313. Published online July 23, 2019; DOI: https://doi.org/10.5946/ce.2019.056

Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficult to distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosing subepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguish between tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyperenhancement pattern in gastrointestinal stromal tumors (sensitivity, 78%–100%; specificity, 60%–100%; accuracy, 60%–100%) and hypoenhancement pattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimate the malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels inside the tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection of vascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated by evaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrastenhanced ultrasound. However, there will be subjective-bias and the results depends on the performer’s skill.

Citations

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Original Article

Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumors: Takashi Tamura, Yasunobu Yamashita, Kazuki Ueda, Yuki Kawaji, Masahiro Itonaga, Shin-ichi Murata, Kaori Yamamoto, Takeichi Yoshida, Hiroki Maeda, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, Jun Kato; Clin Endosc 2017;50(4):372-378. Published online January 20, 2017; DOI: https://doi.org/10.5946/ce.2016.083

Abstract PDF PubReader ePub

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.

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