Ikehara Hisatomo, Li Zhaoliang, Watari Jiro, Taki Masato, Ogawa Tomohiro, Yamasaki Takahisa, Kondo Takashi, Toyoshima Fumihiko, Kono Tomoaki, Tozawa Katsuyuki, Ohda Yoshio, Tomita Toshihiko, Oshima Tadayuki, Fukui Hirokazu, Matsuda Ikuo, Hirota Seiichi, Miwa Hiroto
Hisatomo Ikehara, Zhaoliang Li, Jiro Watari, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Toshihiko Tomita, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
World J Gastrointest Endosc. 2015 Oct 10;7(14):1142-9. doi: 10.4253/wjge.v7.i14.1142.
To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) without cytology and mucosal cutting biopsy (MCB) in the histological diagnosis of gastric submucosal tumor (SMT).
We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥ 1 cm in diameter. who underwent both EUS-FNAB and MCB were investigated.
The histological diagnoses were gastrointestinal stromal tumors (n = 7), leiomyoma (n = 6), schwannoma (n = 2), aberrant pancreas (n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method (P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUS-FNAB (P = 0.03). No complications were found in either method.
MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUS-FNAB should be performed for SMTs with extraluminal growth.
比较内镜超声引导下无细胞学检查的细针穿刺活检（EUS-FNAB）与黏膜切开活检（MCB）在胃黏膜下肿瘤（SMT）组织学诊断中的应用价值。
我们前瞻性地比较了基于内镜黏膜下剥离术的EUS-FNAB和MCB的诊断率、可行性和安全性。对连续20例直径≥1 cm的胃SMT患者进行了研究，这些患者均接受了EUS-FNAB和MCB。
组织学诊断为胃肠道间质瘤（n = 7）、平滑肌瘤（n = 6）、神经鞘瘤（n = 2）、异位胰腺（n = 2），各有1例分别为血管球瘤、转移性肝细胞癌，还有1例未明确诊断。肿瘤平均大小为23.6 mm。EUS-FNAB的组织学诊断率为65.0%，MCB的组织学诊断率为60.0%，差异无统计学意义。两种方法在肿瘤位置或肿瘤大小的诊断率方面无显著差异。然而，MCB方法在腔内生长的病变中获得诊断标本的频率显著高于腔外生长的病变（P = 0.01）。所有4例腔外生长的SMT仅通过EUS-FNAB确诊（P = 0.03）。两种方法均未发现并发症。
对于显示腔内生长模式的肿瘤，无论肿瘤大小，MCB可作为一种替代诊断方式；而对于腔外生长的SMT，应进行EUS-FNAB。
