EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?
Abstract
:1. Introduction
2. Methods
3. Types of Lesions
3.1. Extrinsic Compressions
3.2. Subepithelial Lesions
3.3. Epithelial Lesions Mimicking SELs
Type | Origin | EUS Morphology | Malignant Potential | Biopsy Needed | IHC | No. Cases |
---|---|---|---|---|---|---|
Sarcoma (leiomyosarcoma, liposarcoma, synovial) | 2nd, 3rd, 4th | Nonspecific | NR | Yes | CD117− Desmin+ SMA+ | 100, 38, 36 respectively |
Hemangioma | 3rd, 4th | EGD: bluish black intramural lesion EUS: similar to GIST, calcifications, Doppler signal in case of cavernous transformation | Rarely | No | NR | At least 70 |
Inflammatory myofibroblastic tumor | 4th | Hypoechoic, heterogenous, ill-defined borders, oval shape | Rarely | Yes | SMA+, ALK, CD34+ | 19 |
Plexiform myxofibroma | 3rd | Hypoechoic, homogenous, irregular shape, well-defined borders, possible mucosal invasion with ulceration, almost always in the antrum | No | Yes | SMA+, CD117− Vimentin+ | Approx. 130 |
Desmoid fibromatosis | 4th | Hypoechoic, well-defined borders | No | Yes | b-catenin+ SMA+, CD117− | 9 |
Calcifying fibrous tumor | All, mostly 3rd | Heterogenous, mostly iso-hypoechoic calcifications, well-defined borders | No | Yes | Various markers 25% Vimentin+ | Approx. 300 |
Gastric wall abscess | 3rd, 4th | Hypoechoic, heterogenous | No | No | NR | Approx. 500 |
Idiopathic granulomatous gastritis | 4th | Hypoechoic mass | No | Yes | Multinodular Granulomas | <50 |
Lipomatous hemangiopericytoma | Not clearly stated | Hyperechoic, oval shape, well-defined borders | Unclear | Yes | CD34+ CD99+ Vimentin+ | 1 |
4. Tissue Acquisition
4.1. Indications
4.2. EUS-Guided Fine-Needle Biopsy
4.3. EUS-Guided Fine Needle Aspiration
4.4. Other Biopsy Methods
4.5. Forward-Viewing vs. Oblique-Viewing Echoendoscope
5. New Diagnostic Modalities of EUS without Biopsy
5.1. Contrast-Enhanced EUS
5.2. EUS-Elastography
5.3. Artificial Intelligence in Endoscopic Ultrasound
5.4. Critical Appraisal of the Evidence
6. The Role of Cross-Sectional Imaging in the Diagnosis of Gastric SELs
7. Follow-Up
8. Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Hedenbro, J.L.; Ekelund, M.; Wetterberg, P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg. Endosc. 1991, 5, 20–23. [Google Scholar] [CrossRef]
- Jacobson, B.C.; Bhatt, A.; Greer, K.B.; Lee, L.S.; Park, W.G.; Sauer, B.G.; Shami, V.M. ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am. J. Gastroenterol. 2023, 118, 46–58. [Google Scholar] [CrossRef]
- Polkowski, M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy 2005, 37, 635–645. [Google Scholar] [CrossRef]
- Deprez, P.H.; Moons, L.M.G.; O’Toole, D.; Gincul, R.; Seicean, A.; Pimentel-Nunes, P.; Fernández-Esparrach, G.; Polkowski, M.; Vieth, M.; Borbath, I.; et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022, 54, 412–429. [Google Scholar] [CrossRef]
- Akahoshi, K.; Oya, M.; Koga, T.; Koga, H.; Motomura, Y.; Kubokawa, M.; Gibo, J.; Nakamura, K. Clinical usefulness of endoscopic ultrasound-guided fine needle aspiration for gastric subepithelial lesions smaller than 2 cm. J. Gastrointest. Liver Dis. JGLD 2014, 23, 405–412. [Google Scholar] [CrossRef] [Green Version]
- de Moura, D.T.H.; McCarty, T.R.; Jirapinyo, P.; Ribeiro, I.B.; Flumignan, V.K.; Najdawai, F.; Ryou, M.; Lee, L.S.; Thompson, C.C. EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: A large multicenter study. Gastrointest. Endosc. 2020, 92, 108–119.e103. [Google Scholar] [CrossRef]
- Ramesh, J.; Lal, S.; Martin, D.F.; Crampton, J.R. Subepithelial gastric lesions: Don’t forget to look behind the stomach! Gastrointest. Endosc. 2007, 65, 706–707. [Google Scholar] [CrossRef]
- Chen, G.; Nie, L.; Zhang, T. An extremely rare case of a gastric accessory spleen: Case report and review of the literature. BMC Gastroenterol. 2021, 21, 275. [Google Scholar] [CrossRef]
- Rösch, T.; Kapfer, B.; Will, U.; Baronius, W.; Strobel, M.; Lorenz, R.; Ulm, K. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: A prospective multicenter study. Scand. J. Gastroenterol. 2002, 37, 856–862. [Google Scholar] [CrossRef]
- Papanikolaou, I.S.; Triantafyllou, K.; Kourikou, A.; Rösch, T. Endoscopic ultrasonography for gastric submucosal lesions. World J. Gastrointest. Endosc. 2011, 3, 86–94. [Google Scholar] [CrossRef]
- Boyce, G.A.; Sivak, M.V., Jr.; Rösch, T.; Classen, M.; Fleischer, D.E.; Boyce, H.W., Jr.; Lightdale, C.J.; Botet, J.F.; Hawes, R.H.; Lehman, G.A. Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound. Gastrointest. Endosc. 1991, 37, 449–454. [Google Scholar] [CrossRef]
- Zhong, Z.; Xu, Y.; Liu, J.; Zhang, C.; Xiao, Z.; Xia, Y.; Wang, Y.; Wang, J.; Xu, Q.; Lu, Y. Clinicopathological study of gastric schwannoma and review of related literature. BMC Surg. 2022, 22, 159. [Google Scholar] [CrossRef]
- Kang, H.C.; Menias, C.O.; Gaballah, A.H.; Shroff, S.; Taggart, M.W.; Garg, N.; Elsayes, K.M. Beyond the GIST: Mesenchymal tumors of the stomach. Radiographics 2013, 33, 1673–1690. [Google Scholar] [CrossRef] [Green Version]
- Yang, C.W.; Yen, H.H. Endoscopic sonography in the diagnosis and treatment of a gastric wall abscess: A case report and review of the literature. J. Clin. Ultrasound JCU 2012, 40, 105–108. [Google Scholar] [CrossRef]
- Igarashi, R.; Irisawa, A.; Shibukawa, G.; Soeta, N.; Sato, A.; Yamabe, A.; Fujisawa, M.; Arakawa, N.; Yoshida, Y.; Ikeda, T.; et al. Case Report of a Small Gastric Neuroendocrine Tumor in a Deep Layer of Submucosa with Diagnosis by Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Treatment With Laparoscopic and Endoscopic Cooperative Surgery. Clin. Med. Insights Case Rep. 2018, 11, 1179547617749226. [Google Scholar] [CrossRef]
- Rübenthaler, J.; Auernhammer, C.; Harun, I.; Ricke, J.; Cyran, C.C. Neuroendocrine tumors of the stomach, duodenum and pancreas: Value of (hybrid) radiological diagnostics. Der Radiol. 2019, 59, 961–967. [Google Scholar] [CrossRef]
- Imamura, S.; Nakamura, K.; Takarabe, S.; Arahata, K.; Katayama, T.; Ojiro, K.; Kishikawa, H.; Sasaki, A.; Hasegawa, H.; Nishida, J. A case of early gastric cancer resembling a subepithelial lesion diagnosed by endoscopic ultrasound-guided fine needle aspiration. Clin. J. Gastroenterol. 2022, 15, 1048–1054. [Google Scholar] [CrossRef]
- Kato, M.; Hayashi, Y.; Fukumoto, K.; Nagai, K.; Tsujii, Y.; Shinzaki, S.; Iijima, H.; Takehara, T. Early gastric cancer with lymphoid stroma presenting as a subepithelial lesion diagnosed by endoscopic submucosal dissection. Clin. J. Gastroenterol. 2018, 11, 382–385. [Google Scholar] [CrossRef]
- Jing, H.B.; Meng, Q.D.; Tai, Y.H. Lipomatous hemangiopericytoma of the stomach: A case report and a review of literature. World J. Gastroenterol. 2011, 17, 4835–4838. [Google Scholar] [CrossRef]
- Lin, M.; Song, L.; Qin, S.; Li, D.; Hou, G.; Li, X. Plexiform fibromyxoma: Case report and literature review. Medicine 2021, 100, e27164. [Google Scholar] [CrossRef]
- Niitsu, H.; Tanabe, K.; Tokumoto, N.; Suzuki, T.; Tanaka, A.; Arihiro, K.; Ohdan, H. Idiopathic granulomatous gastritis resembling a gastrointestinal stromal tumor. Case Rep. Gastroenterol. 2012, 6, 502–509. [Google Scholar] [CrossRef]
- Tsai, M.K.; Chen, H.Y.; Chuang, M.L.; Chen, C.W.; Jong, G.P. Gastric Calcifying Fibrous Tumor: An Easy Misdiagnosis as Gastrointestinal Stromal Tumor—A Systemic Review. Medicina 2020, 56, 541. [Google Scholar] [CrossRef]
- Lee, J.C.; Curtis, D.; Williamson, J.B.; Ligato, S. Gastric Desmoid Fibromatosis—Report of a Rare Mimic of Gastrointestinal Stromal Tumor. Cureus 2021, 13, e19614. [Google Scholar] [CrossRef]
- Bjelovic, M.; Micev, M.; Spica, B.; Babic, T.; Gunjic, D.; Djuric, A.; Pesko, P. Primary inflammatory myofibroblastic tumor of the stomach in an adult woman: A case report and review of the literature. World J. Surg. Oncol. 2013, 11, 35. [Google Scholar] [CrossRef] [Green Version]
- Kang, W.Z.; Xue, L.Y.; Wang, G.Q.; Ma, F.H.; Feng, X.L.; Guo, L.; Li, Y.; Li, W.K.; Tian, Y.T. Liposarcoma of the stomach: Report of two cases and review of the literature. World J. Gastroenterol. 2018, 24, 2776–2784. [Google Scholar] [CrossRef]
- Garg, R.; AlRajjal, A.; Berri, R.; Barawi, M. Primary Gastric Leiomyosarcoma: A Case Report and Review of the Literature. J. Gastrointest. Cancer 2020, 51, 335–340. [Google Scholar] [CrossRef]
- So, I.T.; Cho, K.B.; Lee, J.Y.; Kim, S.J.; Jung, H.I.; Choi, J.H.; Lee, Y.J.; Lee, H.J.; Park, K.S.; Ryu, S.W.; et al. A primary gastric synovial sarcoma: A case report and literature review. Medicine 2017, 96, e8904. [Google Scholar] [CrossRef]
- Hu, J.; Sao, H.; Sun, S. Role of Endoscopic Ultrasound for the Diagnosis of Isolated Gastric Cavernous Haemangioma. J. Clin. Diagn. Res. JCDR 2016, 10, Xd03–Xd04. [Google Scholar] [CrossRef]
- Ebi, M.; Nagao, K.; Sugiyama, T.; Yamamoto, K.; Saito, T.; Kurahashi, S.; Yamaguchi, Y.; Adachi, K.; Tamura, Y.; Izawa, S.; et al. Gastric Plexiform Fibromyxoma Resected Using Nonexposed Endoscopic Wall-Inversion Surgery: A Case Report. Case Rep. Gastroenterol. 2022, 16, 159–164. [Google Scholar] [CrossRef]
- Cheng, B.; Yang, C.; Liu, Z.; Liu, L.; Zhou, L. Primary gastric inflammatory myofibroblastic tumor: A case report. Medicine 2018, 97, e13423. [Google Scholar] [CrossRef]
- Gheorghe, G.; Bacalbasa, N.; Ceobanu, G.; Ilie, M.; Enache, V.; Constantinescu, G.; Bungau, S.; Diaconu, C.C. Gastrointestinal Stromal Tumors—A Mini Review. J. Pers. Med. 2021, 11, 694. [Google Scholar] [CrossRef]
- Sharzehi, K.; Sethi, A.; Savides, T. AGA Clinical Practice Update on Management of Subepithelial Lesions Encountered during Routine Endoscopy: Expert Review. Clin. Gastroenterol. Hepatol. 2022, 20, 2435–2443.e2434. [Google Scholar] [CrossRef]
- Dumonceau, J.M.; Deprez, P.H.; Jenssen, C.; Iglesias-Garcia, J.; Larghi, A.; Vanbiervliet, G.; Aithal, G.P.; Arcidiacono, P.G.; Bastos, P.; Carrara, S.; et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline—Updated January 2017. Endoscopy 2017, 49, 695–714. [Google Scholar] [CrossRef] [Green Version]
- Nishida, T.; Kawai, N.; Yamaguchi, S.; Nishida, Y. Submucosal tumors: Comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig. Endosc. 2013, 25, 479–489. [Google Scholar] [CrossRef]
- Han, J.P.; Lee, T.H.; Hong, S.J.; Kim, H.K.; Noh, H.M.; Lee, Y.N.; Choi, H.J. EUS-guided FNA and FNB after on-site cytological evaluation in gastric subepithelial tumors. J. Dig. Dis. 2016, 17, 582–587. [Google Scholar] [CrossRef]
- Gilani, S.M.; Muniraj, T.; Aslanian, H.R.; Cai, G. Endoscopic ultrasound-guided fine needle aspiration cytology diagnosis of upper gastrointestinal tract mesenchymal tumors: Impact of rapid onsite evaluation and correlation with histopathologic follow-up. Diagn. Cytopathol. 2021, 49, 203–210. [Google Scholar] [CrossRef]
- Trindade, A.J.; Benias, P.C.; Alshelleh, M.; Bazarbashi, A.N.; Tharian, B.; Inamdar, S.; Sharma, N.; Zelt, C.; Korrapati, P.; Barakat, M.; et al. Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: A large multicenter study. Endosc. Int. Open 2019, 7, E931–E936. [Google Scholar] [CrossRef] [Green Version]
- Facciorusso, A.; Sunny, S.P.; Del Prete, V.; Antonino, M.; Muscatiello, N. Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: A meta-analysis. Gastrointest. Endosc. 2020, 91, 14–22.e12. [Google Scholar] [CrossRef]
- Kim, G.H.; Cho, Y.K.; Kim, E.Y.; Kim, H.K.; Cho, J.W.; Lee, T.H.; Moon, J.S. Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand. J. Gastroenterol. 2014, 49, 347–354. [Google Scholar] [CrossRef]
- Kida, M.; Kawaguchi, Y.; Miyata, E.; Hasegawa, R.; Kaneko, T.; Yamauchi, H.; Koizumi, S.; Okuwaki, K.; Miyazawa, S.; Iwai, T.; et al. Endoscopic ultrasonography diagnosis of subepithelial lesions. Dig. Endosc. 2017, 29, 431–443. [Google Scholar] [CrossRef]
- Fujita, A.; Ryozawa, S.; Mizuide, M.; Araki, R.; Nagata, K.; Tanisaka, Y.; Harada, M.; Ogawa, T.; Tashima, T.; Nonaka, K. Does endoscopic ultrasound-guided fine needle biopsy using a Franseen needle really offer high diagnostic accuracy? A propensity-matched analysis. Endosc. Int. Open 2019, 7, E1327–E1332. [Google Scholar] [CrossRef] [Green Version]
- Nagai, K.; Sofuni, A.; Tsuchiya, T.; Kono, S.; Ishii, K.; Tanaka, R.; Tonozuka, R.; Mukai, S.; Yamamoto, K.; Matsunami, Y.; et al. Efficacy of the Franseen needle for diagnosing gastrointestinal submucosal lesions including small tumors. Endosc. Ultrasound 2021, 10, 424–430. [Google Scholar] [CrossRef]
- Sanaei, O.; Fernández-Esparrach, G.; De La Serna-Higuera, C.; Carrara, S.; Kumbhari, V.; El Zein, M.H.; Ismail, A.; Ginès, A.; Sendino, O.; Montenegro, A.; et al. EUS-guided 22-gauge fine needle biopsy versus single-incision with needle knife for the diagnosis of upper gastrointestinal subepithelial lesions: A randomized controlled trial. Endosc. Int. Open 2020, 8, e266–e273. [Google Scholar] [CrossRef] [Green Version]
- Sekine, M.; Miura, T.; Fujiwara, J.; Uehara, T.; Asano, T.; Matsumoto, S.; Miyatani, H.; Mashima, H. Utility of endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for diagnosing small subepithelial lesions (<20 mm). J. Ultrasound 2022, 25, 35–40. [Google Scholar] [CrossRef]
- Faulx, A.L.; Kothari, S.; Acosta, R.D.; Agrawal, D.; Bruining, D.H.; Chandrasekhara, V.; Eloubeidi, M.A.; Fanelli, R.D.; Gurudu, S.R.; Khashab, M.A.; et al. The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest. Endosc. 2017, 85, 1117–1132. [Google Scholar] [CrossRef] [Green Version]
- Iwashita, T.; Yasuda, I.; Mukai, T.; Doi, S.; Nakashima, M.; Uemura, S.; Mabuchi, M.; Shimizu, M.; Hatano, Y.; Hara, A.; et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: A single-center prospective pilot study (MOSE study). Gastrointest. Endosc. 2015, 81, 177–185. [Google Scholar] [CrossRef]
- Chong, C.C.N.; Lakhtakia, S.; Nguyen, N.; Hara, K.; Chan, W.K.; Puri, R.; Almadi, M.A.; Ang, T.L.; Kwek, A.; Yasuda, I.; et al. Endoscopic ultrasound-guided tissue acquisition with or without macroscopic on-site evaluation: Randomized controlled trial. Endoscopy 2020, 52, 856–863. [Google Scholar] [CrossRef]
- Mangiavillano, B.; Frazzoni, L.; Togliani, T.; Fabbri, C.; Tarantino, I.; De Luca, L.; Staiano, T.; Binda, C.; Signoretti, M.; Eusebi, L.H.; et al. Macroscopic on-site evaluation (MOSE) of specimens from solid lesions acquired during EUS-FNB: Multicenter study and comparison between needle gauges. Endosc. Int. Open 2021, 9, e901–e906. [Google Scholar] [CrossRef]
- Gaia, S.; Rizza, S.; Bruno, M.; Ribaldone, D.G.; Maletta, F.; Sacco, M.; Pacchioni, D.; Rizzi, F.; Saracco, G.M.; Fagoonee, S.; et al. Impact of Macroscopic On-Site Evaluation (MOSE) on Accuracy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy (EUS-FNB) of Pancreatic and Extrapancreatic Solid Lesions: A Prospective Study. Diagnostics 2022, 12, 428. [Google Scholar] [CrossRef]
- Sekine, M.; Asano, T.; Mashima, H. The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics 2022, 12, 810. [Google Scholar] [CrossRef]
- Watson, R.R.; Binmoeller, K.F.; Hamerski, C.M.; Shergill, A.K.; Shaw, R.E.; Jaffee, I.M.; Stewart, L.; Shah, J.N. Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors. Dig. Dis. Sci. 2011, 56, 1757–1762. [Google Scholar] [CrossRef]
- Akahoshi, K.; Sumida, Y.; Matsui, N.; Oya, M.; Akinaga, R.; Kubokawa, M.; Motomura, Y.; Honda, K.; Watanabe, M.; Nagaie, T. Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J. Gastroenterol. 2007, 13, 2077–2082. [Google Scholar] [CrossRef]
- Kim, D.H.; Park, C.H.; Park, S.Y.; Cho, E.; Kim, H.S.; Choi, S.K. Diagnostic yields of endoscopic ultrasound-guided fine-needle tissue acquisition according to the gastric location. Medicine 2021, 100, e26477. [Google Scholar] [CrossRef]
- Suzuki, T.; Arai, M.; Matsumura, T.; Arai, E.; Hata, S.; Maruoka, D.; Tanaka, T.; Nakamoto, S.; Imazeki, F.; Yokosuka, O. Factors Associated with Inadequate Tissue Yield in EUS-FNA for Gastric SMT. ISRN Gastroenterol. 2011, 2011, 619128. [Google Scholar] [CrossRef] [Green Version]
- Eckardt, A.J.; Adler, A.; Gomes, E.M.; Jenssen, C.; Siebert, C.; Gottschalk, U.; Koch, M.; Röcken, C.; Rösch, T. Endosonographic large-bore biopsy of gastric subepithelial tumors: A prospective multicenter study. Eur. J. Gastroenterol. Hepatol. 2012, 24, 1135–1144. [Google Scholar] [CrossRef]
- Imazu, H.; Uchiyama, Y.; Kakutani, H.; Ikeda, K.; Sumiyama, K.; Kaise, M.; Omar, S.; Ang, T.L.; Tajiri, H. A prospective comparison of EUS-guided FNA using 25-gauge and 22-gauge needles. Gastroenterol. Res. Pract. 2009, 2009, 546390. [Google Scholar] [CrossRef] [Green Version]
- Khoury, T.; Kadah, A.; Farraj, M.; Barhoum, M.; Livoff, A.; Mari, A.; Mahamid, M.; Sbeit, W. The role of rapid on-site evaluation on diagnostic accuracy of endoscopic ultrasound fine needle aspiration for pancreatic, submucosal upper gastrointestinal tract and adjacent lesions. Cytopathology 2019, 30, 499–503. [Google Scholar] [CrossRef]
- Tamura, T.; Yamashita, Y.; Ueda, K.; Kawaji, Y.; Itonaga, M.; Murata, S.I.; Yamamoto, K.; Yoshida, T.; Maeda, H.; Maekita, T.; et al. Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumors. Clin. Endosc. 2017, 50, 372–378. [Google Scholar] [CrossRef] [Green Version]
- Minoda, Y.; Chinen, T.; Osoegawa, T.; Itaba, S.; Haraguchi, K.; Akiho, H.; Aso, A.; Sumida, Y.; Komori, K.; Ogino, H.; et al. Superiority of mucosal incision-assisted biopsy over ultrasound-guided fine needle aspiration biopsy in diagnosing small gastric subepithelial lesions: A propensity score matching analysis. BMC Gastroenterol. 2020, 20, 19. [Google Scholar] [CrossRef] [Green Version]
- Osoegawa, T.; Minoda, Y.; Ihara, E.; Komori, K.; Aso, A.; Goto, A.; Itaba, S.; Ogino, H.; Nakamura, K.; Harada, N.; et al. Mucosal incision-assisted biopsy versus endoscopic ultrasound-guided fine-needle aspiration with a rapid on-site evaluation for gastric subepithelial lesions: A randomized cross-over study. Dig. Endosc. 2019, 31, 413–421. [Google Scholar] [CrossRef] [Green Version]
- Matsuzaki, I.; Miyahara, R.; Hirooka, Y.; Funasaka, K.; Ohno, E.; Nakamura, M.; Kawashima, H.; Nukaga, A.; Shimoyama, Y.; Goto, H. Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: A prospective, randomized, crossover study. Gastrointest. Endosc. 2015, 82, 287–295. [Google Scholar] [CrossRef]
- Yamabe, A.; Irisawa, A.; Bhutani, M.S.; Shibukawa, G.; Abe, Y.; Saito, A.; Imbe, K.; Hoshi, K.; Igarashi, R. Usefulness of endoscopic ultrasound-guided fine-needle aspiration with a forward-viewing and curved linear-array echoendoscope for small gastrointestinal subepithelial lesions. Endosc. Int. Open 2015, 3, E161–E164. [Google Scholar] [CrossRef]
- Larghi, A.; Ibrahim, M.; Fuccio, L.; Lekkerkerker, S.; Eisendrath, P.; Frazzoni, L.; Fockens, P.; La Marca, M.; van Hooft, J.E.; Deviere, J.; et al. Forward-viewing echoendoscope versus standard echoendoscope for endoscopic ultrasound-guided tissue acquisition of solid lesions: A randomized, multicenter study. Endoscopy 2019, 51, 444–451. [Google Scholar] [CrossRef]
- Ignee, A.; Jenssen, C.; Hocke, M.; Dong, Y.; Wang, W.P.; Cui, X.W.; Woenckhaus, M.; Iordache, S.; Saftoiu, A.; Schuessler, G.; et al. Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors. Endosc. Ultrasound 2017, 6, 55–60. [Google Scholar] [CrossRef] [Green Version]
- Kannengiesser, K.; Mahlke, R.; Petersen, F.; Peters, A.; Ross, M.; Kucharzik, T.; Maaser, C. Contrast-enhanced harmonic endoscopic ultrasound is able to discriminate benign submucosal lesions from gastrointestinal stromal tumors. Scand. J. Gastroenterol. 2012, 47, 1515–1520. [Google Scholar] [CrossRef]
- Kamata, K.; Takenaka, M.; Kitano, M.; Omoto, S.; Miyata, T.; Minaga, K.; Yamao, K.; Imai, H.; Sakurai, T.; Watanabe, T.; et al. Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract. J. Gastroenterol. Hepatol. 2017, 32, 1686–1692. [Google Scholar] [CrossRef]
- Tamura, T.; Kitano, M. Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors. Clin. Endosc. 2019, 52, 306–313. [Google Scholar] [CrossRef]
- Tang, J.Y.; Tao, K.G.; Zhang, L.Y.; Wu, K.M.; Shi, J.; Zeng, X.; Lin, Y. Value of contrast-enhanced harmonic endoscopic ultrasonography in differentiating between gastrointestinal stromal tumors: A meta-analysis. J. Dig. Dis. 2019, 20, 127–134. [Google Scholar] [CrossRef]
- Sakamoto, H.; Kitano, M.; Matsui, S.; Kamata, K.; Komaki, T.; Imai, H.; Dote, K.; Kudo, M. Estimation of malignant potential of GI stromal tumors by contrast-enhanced harmonic EUS (with videos). Gastrointest. Endosc. 2011, 73, 227–237. [Google Scholar] [CrossRef]
- Yamashita, Y.; Kato, J.; Ueda, K.; Nakamura, Y.; Abe, H.; Tamura, T.; Itonaga, M.; Yoshida, T.; Maeda, H.; Moribata, K.; et al. Contrast-enhanced endoscopic ultrasonography can predict a higher malignant potential of gastrointestinal stromal tumors by visualizing large newly formed vessels. J. Clin. Ultrasound JCU 2015, 43, 89–97. [Google Scholar] [CrossRef]
- Wu, J.; Zhuang, M.; Zhou, Y.; Zhan, X.; Xie, W. The value of contrast-enhanced harmonic endoscopic ultrasound in differential diagnosis and evaluation of malignant risk of gastrointestinal stromal tumors (<50 mm). Scand. J. Gastroenterol. 2022, 58, 542–548. [Google Scholar] [CrossRef]
- Pallio, S.; Crinò, S.F.; Maida, M.; Sinagra, E.; Tripodi, V.F.; Facciorusso, A.; Ofosu, A.; Conti Bellocchi, M.C.; Shahini, E.; Melita, G. Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours. Cancers 2023, 15, 1285. [Google Scholar] [CrossRef]
- Iglesias-Garcia, J.; Lindkvist, B.; Lariño-Noia, J.; Domínguez-Muñoz, J.E. Endoscopic ultrasound elastography. Endosc. Ultrasound 2012, 1, 8–16. [Google Scholar] [CrossRef]
- Tsuji, Y.; Kusano, C.; Gotoda, T.; Itokawa, F.; Fukuzawa, M.; Sofuni, A.; Matsubayashi, J.; Nagao, T.; Itoi, T.; Moriyasu, F. Diagnostic potential of endoscopic ultrasonography-elastography for gastric submucosal tumors: A pilot study. Dig. Endosc. 2016, 28, 173–178. [Google Scholar] [CrossRef]
- Kim, S.H.; Yoo, I.K.; Kwon, C.I.; Hong, S.P.; Cho, J.Y. Utility of EUS elastography in the diagnosis of gastric subepithelial tumors: A pilot study (with video). Gastrointest. Endosc. 2020, 91, 172–177.e172. [Google Scholar] [CrossRef]
- Guo, J.; Bai, T.; Ding, Z.; Du, F.; Liu, S. Efficacy of Endoscopic Ultrasound Elastography in Differential Diagnosis of Gastrointestinal Stromal Tumor Versus Gastrointestinal Leiomyoma. Med. Sci. Monit. 2021, 27, e927619. [Google Scholar] [CrossRef]
- Okagawa, Y.; Abe, S.; Yamada, M.; Oda, I.; Saito, Y. Artificial Intelligence in Endoscopy. Dig. Dis. Sci. 2022, 67, 1553–1572. [Google Scholar] [CrossRef]
- Minoda, Y.; Ihara, E.; Komori, K.; Ogino, H.; Otsuka, Y.; Chinen, T.; Tsuda, Y.; Ando, K.; Yamamoto, H.; Ogawa, Y. Efficacy of endoscopic ultrasound with artificial intelligence for the diagnosis of gastrointestinal stromal tumors. J. Gastroenterol. 2020, 55, 1119–1126. [Google Scholar] [CrossRef]
- Hirai, K.; Kuwahara, T.; Furukawa, K.; Kakushima, N.; Furune, S.; Yamamoto, H.; Marukawa, T.; Asai, H.; Matsui, K.; Sasaki, Y.; et al. Artificial intelligence-based diagnosis of upper gastrointestinal subepithelial lesions on endoscopic ultrasonography images. Gastric Cancer 2022, 25, 382–391. [Google Scholar] [CrossRef]
- Kim, Y.H.; Kim, G.H.; Kim, K.B.; Lee, M.W.; Lee, B.E.; Baek, D.H.; Kim, D.H.; Park, J.C. Application of A Convolutional Neural Network in The Diagnosis of Gastric Mesenchymal Tumors on Endoscopic Ultrasonography Images. J. Clin. Med. 2020, 9, 3162. [Google Scholar] [CrossRef]
- Seven, G.; Silahtaroglu, G.; Kochan, K.; Ince, A.T.; Arici, D.S.; Senturk, H. Use of Artificial Intelligence in the Prediction of Malignant Potential of Gastric Gastrointestinal Stromal Tumors. Dig. Dis. Sci. 2022, 67, 273–281. [Google Scholar] [CrossRef]
- Goto, O.; Kambe, H.; Niimi, K.; Mochizuki, S.; Asada-Hirayama, I.; Minatsuki, C.; Ono, S.; Kodashima, S.; Yamamichi, N.; Yamaji, Y.; et al. Discrepancy in diagnosis of gastric submucosal tumor among esophagogastroduodenoscopy, CT, and endoscopic ultrasonography: A retrospective analysis of 93 consecutive cases. Abdom. Imaging 2012, 37, 1074–1078. [Google Scholar] [CrossRef]
- Ra, J.C.; Lee, E.S.; Lee, J.B.; Kim, J.G.; Kim, B.J.; Park, H.J.; Park, S.B.; Choi, B.I. Diagnostic performance of stomach CT compared with endoscopic ultrasonography in diagnosing gastric subepithelial tumors. Abdom. Radiol. 2017, 42, 442–450. [Google Scholar] [CrossRef]
- Liu, M.; Liu, L.; Jin, E. Gastric sub-epithelial tumors: Identification of gastrointestinal stromal tumors using CT with a practical scoring method. Gastric Cancer 2019, 22, 769–777. [Google Scholar] [CrossRef] [Green Version]
- Huh, C.W.; Jung, D.H.; Kim, J.S.; Shin, Y.R.; Choi, S.H.; Kim, B.W. CT Versus Endoscopic Ultrasound for Differentiating Small (2–5 cm) Gastrointestinal Stromal Tumors from Leiomyomas. AJR. Am. J. Roentgenol. 2019, 213, 586–591. [Google Scholar] [CrossRef]
- Kim, S.Y.; Shim, K.N.; Lee, J.H.; Lim, J.Y.; Kim, T.O.; Choe, A.R.; Tae, C.H.; Jung, H.K.; Moon, C.M.; Kim, S.E.; et al. Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors. Clin. Endosc. 2019, 52, 565–573. [Google Scholar] [CrossRef] [Green Version]
- Yoo, J.; Kim, S.H.; Han, J.K. Multiparametric MRI and (18)F-FDG PET features for differentiating gastrointestinal stromal tumors from benign gastric subepithelial lesions. Eur. Radiol. 2020, 30, 1634–1643. [Google Scholar] [CrossRef]
- ESMO/European Sarcoma Network Working Group. Gastrointestinal Stromal Tumours: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Ann. Oncol. 2014, 25 (Suppl. S3), III21–III26. [Google Scholar] [CrossRef]
- Parab, T.M.; DeRogatis, M.J.; Boaz, A.M.; Grasso, S.A.; Issack, P.S.; Duarte, D.A.; Urayeneza, O.; Vahdat, S.; Qiao, J.H.; Hinika, G.S. Gastrointestinal stromal tumors: A comprehensive review. J. Gastrointest. Oncol. 2019, 10, 144–154. [Google Scholar] [CrossRef]
- Miettinen, M.; Lasota, J. Gastrointestinal stromal tumors: Pathology and prognosis at different sites. Semin. Diagn. Pathol. 2006, 23, 70–83. [Google Scholar] [CrossRef]
- Casali, P.G.; Blay, J.Y.; Abecassis, N.; Bajpai, J.; Bauer, S.; Biagini, R.; Bielack, S.; Bonvalot, S.; Boukovinas, I.; Bovee, J.; et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2022, 33, 20–33. [Google Scholar] [CrossRef]
- Landi, B.; Blay, J.Y.; Bonvalot, S.; Brasseur, M.; Coindre, J.M.; Emile, J.F.; Hautefeuille, V.; Honore, C.; Lartigau, E.; Mantion, G.; et al. Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig. Liver Dis. 2019, 51, 1223–1231. [Google Scholar] [CrossRef]
- Song, J.H.; Kim, S.G.; Chung, S.J.; Kang, H.Y.; Yang, S.Y.; Kim, Y.S. Risk of progression for incidental small subepithelial tumors in the upper gastrointestinal tract. Endoscopy 2015, 47, 675–679. [Google Scholar] [CrossRef]
- Ye, L.S.; Li, Y.; Liu, W.; Yao, M.H.; Khan, N.; Hu, B. Clinical course of suspected small gastrointestinal stromal tumors in the stomach. World J. Gastrointest. Surg. 2020, 12, 171–177. [Google Scholar] [CrossRef]
- Liu, Z.; Guo, J.; Sun, S.; Ren, W.; Tang, S.; Xie, L.; Huang, L. Evaluation of transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent for demonstrating small gastric subepithelial masses. Abdom. Imaging 2014, 39, 424–431. [Google Scholar] [CrossRef]
- Tsai, T.L.; Changchien, C.S.; Hu, T.H.; Hsiaw, C.M. Demonstration of gastric submucosal lesions by high-resolution transabdominal sonography. J. Clin. Ultrasound JCU 2000, 28, 125–132. [Google Scholar] [CrossRef]
SEL Type | Origin | EUS Morphology | Border | Location in Stomach | Malignant Potential | Biopsy Needed |
---|---|---|---|---|---|---|
Duplication cyst | 3rd/ external | Anechoic, no Doppler signal | Sharp | Any | Very Rarely | No |
Varices | 3rd | Anechoic with Doppler signal | Sharp, serpiginous shape | Any | No | No |
Lymphangiomas | 3rd | Anechoic, no Doppler signal, with internal septa | Sharp | Any | No | Yes |
Lipoma | 3rd | Hyperechoic, homogenous | Sharp | Any | No | No |
Glomus Tumor | 3rd/4th | Hypo/Hyperechoic Hypervascular with internal echo | Sharp | Any | Rarely | Yes |
NET | 1st/2nd 3rd | Hypoechoic/hyperechoic | Sharp | Any | Yes | Yes |
GIST low risk | 2nd/4th | Hypoechoic, heterogenous, hypervascular | Sharp when benign | Any | Yes | Yes |
GIST high risk | 2nd/4th | Hypoechoic, heterogeneous with cystic space or echogenic foci | Irregular > 3 cm | Any | Yes | Yes |
Leiomyoma | 2nd/4th | Hypoechoic, rarely multifocal | Sharp | Cardia | No | Yes |
Lymphoma | 2nd/3rd/4th | Hypoechoic | Irregular | Any | Malignant | Yes |
Inflammatory fibroid Polyp | 2nd/3rd | Hypoechoic, homogenous, polypoid | Indistinct | Antrum | No | Yes |
Ectopic pancreas | 3rd/4th | Hypoechoic, heterogenous, with cysts or ducts inside | Indistinct | Antrum | Very rarely | Sometimes |
Schwannoma | 4th | Hypoechoic, homogenous, sometimes with marginal halo | Sharp | Body | No | Yes |
Metastasis | Any | Hypoechoic | Irregular | Any | Malignant | Yes |
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Vasilakis, T.; Ziogas, D.; Tziatzios, G.; Gkolfakis, P.; Koukoulioti, E.; Kapizioni, C.; Triantafyllou, K.; Facciorusso, A.; Papanikolaou, I.S. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics 2023, 13, 2176. https://doi.org/10.3390/diagnostics13132176
Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, Triantafyllou K, Facciorusso A, Papanikolaou IS. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics. 2023; 13(13):2176. https://doi.org/10.3390/diagnostics13132176
Chicago/Turabian StyleVasilakis, Thomas, Dimitrios Ziogas, Georgios Tziatzios, Paraskevas Gkolfakis, Eleni Koukoulioti, Christina Kapizioni, Konstantinos Triantafyllou, Antonio Facciorusso, and Ioannis S. Papanikolaou. 2023. "EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?" Diagnostics 13, no. 13: 2176. https://doi.org/10.3390/diagnostics13132176