Gastroenterology Department, Portuguese Oncology Institute.
Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS).
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(12):1533-1538. doi: 10.1097/MEG.0000000000002108.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for acquisition of tissue from gastrointestinal subepithelial lesions (SELs). Despite the development of new needles, diagnostic yield remains low. A new method of aspiration has been described, where the needle is filled with saline [wet-suction technique (WST)], with promising results in pancreatic lesions. This method has not been tested in SELs.
Prospective single center study to assess the diagnostic yield of EUS-FNA+WST in the diagnosis of SELs, without the use of rapid on-site evaluation. In mesenchymal tumors, the diagnosis was considered positive only when immunohistochemistry could differentiate between gastrointestinal stromal tumor and leiomyoma.
Eighty-seven patients with SELs were included (55% male, mean age 66 years). Mean SEL size was 25 mm (min 10 mm, max 120 mm), mean number of passes was 3 (±0.8). A 22G needle was used in 72 patients (83%), 19G in 10 (12%) and 25G in 5 (6%). We obtained a conclusive cytopathological diagnosis in 74 cases (diagnostic yield of 85%) and immunohistochemistry was performed in 70 cases (81%). The most frequent diagnoses were gastrointestinal stromal tumor (n = 34, 37%), leiomyoma (n = 13, 15%) and metastases (n = 10, 11%).
Wet suction technique allowed an excellent diagnostic yield in the EUS-guided evaluation of SELs. We suggest that, after proper replication of these results, WST may become the first-line method in the management of these lesions.
内镜超声引导下细针抽吸（EUS-FNA）是获取胃肠道黏膜下病变（SEL）组织的主要方法。尽管新针具不断发展，但诊断率仍然较低。一种新的抽吸方法已经被描述，即在针内注入盐水[湿吸技术（WST）]，在胰腺病变中取得了有前景的结果。这种方法尚未在 SEL 中进行测试。
这是一项前瞻性单中心研究，旨在评估 EUS-FNA+WST 在诊断 SEL 中的诊断率，而不使用现场快速评估。在间叶性肿瘤中，只有当免疫组织化学能够区分胃肠道间质瘤和平滑肌瘤时，才认为诊断为阳性。
共纳入 87 例 SEL 患者（55%为男性，平均年龄 66 岁）。平均 SEL 大小为 25mm（最小 10mm，最大 120mm），平均穿刺次数为 3（±0.8）。72 例患者使用 22G 针（83%），10 例患者使用 19G 针（12%），5 例患者使用 25G 针（6%）。我们在 74 例（诊断率 85%）中获得了明确的细胞学诊断，并对 70 例（81%）进行了免疫组织化学检查。最常见的诊断是胃肠道间质瘤（n=34，37%）、平滑肌瘤（n=13，15%）和转移瘤（n=10，11%）。
湿吸技术在内镜超声引导下 SEL 评估中获得了极好的诊断率。我们建议，在适当复制这些结果后，WST 可能成为这些病变管理的首选方法。
