黏膜切除活检对胃黏膜下肿瘤组织病理学诊断的效能
Efficacy of Mucosal Cutting Biopsy for the Histopathological Diagnosis of Gastric Submucosal Tumors.
作者信息
Adachi Akihisa, Hirata Yoshikazu, Kawamura Hayato, Harada Takahito, Hattori Reika, Kumai Daisuke, Yamamoto Yuki, Kojima Yuki, Ikeuchi Hirokazu, Hayashi Noriyuki, Mochizuki Hisato, Takada Hiroki, Yamaguchi Ryuzo, Sobue Satoshi
机构信息
Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan.
Department of Surgery, Kasugai Municipal Hospital, Kasugai, Japan.
出版信息
Case Rep Gastroenterol. 2019 Apr 9;13(1):185-194. doi: 10.1159/000499442. eCollection 2019 Jan-Apr.
BACKGROUND
Gastrointestinal stromal tumors occur frequently. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed commonly for diagnosis. However, the success rate of histological diagnosis is insufficient when the submucosal tumor (SMT) is small. Recently, another technique, mucosal cutting biopsy (MCB) has been reported. The aim of this study is to evaluate the efficacy and safety of MCB.
METHOD
Between January 2012 and August 2018, MCB and EUS-FNA were performed 16 and 31 times for diagnosing gastric SMT. The diagnostic rate, the rate of successful immunohistochemistry, and the safety were reviewed. Difficult locations for EUS-FNA were also evaluated.
RESULTS
The mean SMT sizes measured on MCB and EUS-FNA were 21.2 and 36.2 mm. The diagnostic rates of MCB and EUS-FNA were almost the same (88 vs. 81%), but successful immunohistochemistry was significantly higher in the MCB group (93 vs. 59%, = 0.03). In the subgroup of SMTs < 20 mm, the successful histological diagnosis rate from EUS-FNA was relatively low. There were no complications. Failures of EUS-FNA were more frequent in the middle third of the stomach.
CONCLUSIONS
MCB was an effective procedure for diagnosing gastric SMT, especially in the case of small SMTs located at the middle third of the stomach.
背景
胃肠道间质瘤较为常见。内镜超声引导下细针穿刺抽吸术（EUS-FNA）常用于诊断。然而，当黏膜下肿瘤（SMT）较小时，组织学诊断的成功率不足。最近，另一种技术，即黏膜切割活检（MCB）已被报道。本研究的目的是评估MCB的有效性和安全性。
方法
在2012年1月至2018年8月期间，分别进行了16次和31次MCB及EUS-FNA用于诊断胃SMT。回顾了诊断率、免疫组化成功率及安全性。还评估了EUS-FNA的困难部位。
结果
MCB和EUS-FNA测量的SMT平均大小分别为21.2和36.2mm。MCB和EUS-FNA的诊断率几乎相同（88%对81%），但MCB组免疫组化成功率显著更高（93%对59%，P=0.03）。在SMT<20mm的亚组中，EUS-FNA的组织学诊断成功率相对较低。无并发症发生。EUS-FNA失败在胃的中三分之一处更常见。
结论
MCB是诊断胃SMT的有效方法，尤其适用于位于胃中三分之一处的小SMT。
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