Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
J Am Soc Cytopathol. 2020 Nov-Dec;9(6):528-539. doi: 10.1016/j.jasc.2020.05.009. Epub 2020 Jun 10.
Unlike epithelial malignancies, mesenchymal neoplasms arising within the tubular gut are less often encountered in endoscopic ultrasound-guided (EUS) fine-needle aspiration biopsies (FNABs). Nonetheless, preoperative diagnosis of such neoplasms has important therapeutic and prognostic value. We report our experience with this category of neoplasms from the past decade.
We performed a 10-year retrospective search at our respective institutions to identify EUS-guided FNAB cases of mesenchymal neoplasms arising from the tubular gut wall and closely adjacent structures. Cytopathologic diagnoses were compared to corresponding surgical pathology (SP) when available. Cases with either no confirmatory cell block (CB) immunohistochemical (IHC) staining, or no SP were excluded.
Two-hundred eighty-two cases (M:F = 1:1; age range: 25-94 years, mean age = 60 years) of EUS-guided FNAB from the tubular gut met our criteria. Onsite adequacy was performed on nearly all cases. Case numbers: 209 gastrointestinal stromal tumors (GIST), 58 smooth muscle neoplasms, and 15 miscellaneous neoplasms. Of these, 188 (67%) had SP follow-up. We found that 258 (91%) aspirates had a correct specific diagnosis, 3 (1%) were nondiagnostic, 18 (6%) had indeterminate diagnoses, and 3 (1%) had incorrect diagnoses (2 leiomyosarcomas mistaken as leiomyoma, and 1 fibrosclerotic lesion mistaken as inflammatory pseudotumor). Of 94 cases with no SP, all had a specific cytologic diagnosis based on confirmatory IHC staining from the CB including 61 GISTs, 29 smooth muscle neoplasms, and 4 miscellaneous tumors.
This study endorses the clinical utility of EUS-guided FNAB in the diagnosis of tubular gut mesenchymal neoplasms. A definitive and accurate diagnosis is possible in over 90% of cases, chiefly when cytomorphology is coupled with optimal cellularity and IHC from a concurrent CB. EUS-guided FNAB diagnosis of mesenchymal tubular gut neoplasms may play an important role in determining neoadjuvant therapy as targeted therapy evolves.
与上皮性恶性肿瘤不同，管状消化道内发生的间叶性肿瘤在经内镜超声引导（EUS）细针抽吸活检（FNAB）中较少见。然而，此类肿瘤的术前诊断具有重要的治疗和预后价值。我们报告了过去十年中我们在这一类肿瘤方面的经验。
我们在各自的机构中进行了一项为期十年的回顾性研究，以确定源自管状胃肠道壁和相邻结构的 EUS 引导 FNAB 间叶性肿瘤病例。当有手术病理（SP）结果时，将细胞学诊断与 SP 进行比较。排除了既没有确认的细胞块（CB）免疫组织化学（IHC）染色，也没有 SP 的病例。
符合我们标准的 282 例源自管状胃肠道的 EUS 引导 FNAB 病例（M:F=1:1；年龄范围：25-94 岁，平均年龄=60 岁）。几乎所有病例都进行了现场评估。病例数量：209 例胃肠道间质瘤（GIST）、58 例平滑肌肿瘤和 15 例其他肿瘤。其中 188 例（67%）有 SP 随访。我们发现，258 例（91%）抽吸物有正确的特定诊断，3 例（1%）为非诊断性，18 例（6%）为不确定诊断，3 例（1%）为错误诊断（2 例平滑肌肉瘤误诊为平滑肌瘤，1 例纤维硬化性病变误诊为炎症性假瘤）。在 94 例没有 SP 的病例中，所有病例均根据 CB 中的确认性 IHC 染色得出了特定的细胞学诊断，包括 61 例 GIST、29 例平滑肌肿瘤和 4 例其他肿瘤。
本研究证实了 EUS 引导 FNAB 在诊断管状胃肠道间叶性肿瘤中的临床应用价值。在 90%以上的病例中可以做出明确和准确的诊断，主要是当细胞形态学与最佳细胞数量和来自并行 CB 的 IHC 结合时。EUS 引导 FNAB 诊断管状胃肠道间叶性肿瘤可能在确定新辅助治疗方面发挥重要作用，因为靶向治疗正在不断发展。
