EUS-FNA FOR DUODENAL HYPOECHOIC SOLID SUBEPITHELIAL LESION DIAGNOSED BY EUS

Aims:

The frequency of histological types and the usefulness of EUS-FNA for duodenal subepithelial lesions (DSEL) whose EUS image shows a hypoechoic solid mass are still unknown. The aim of this study is to clarify them.

Methods:

From October 2004 to April 2018, 16 consecutive patients who underwent EUS-FNAs for DSEL whose EUS image showed a hypoechoic solid mass were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 12), or clinical follow-up (n = 4). We used 22G or 25G FNA needles and performed rapid on-site cytopathological examination and immunohistochemical analysis in all lesions.

Results:

There were 8 FNA specimens from the duodenal bulb and 8 from the descending portions. The final histopathological diagnoses (Surgery or EUS-FNA) included 9 cases of GIST (56%), 2 cases of leiomyoma (13%), and 1 case each of carcinoid (hereinafter 6% each), malignant lymphoma, cancer, leiomyosarcoma, and gauzeoma. The frequency of malignant tumors in DSEL whose EUS image showed a hypoechoic solid mass, was 81% (13/16). Puncture was not performed because of intervening vessels in one case. The diagnostic rate was 80% (12/15). In 9 surgically resected cases (excluding 3 unsuccessful EUS-FNA cases), the diagnostic accuracy of EUS-FNA was 89% (8/9). There were no complications.

Conclusions:

DSEL whose EUS image showing a hypoechoic solid mass is highly likely to be malignant tumor containing GIST. EUS-FNA for DSEL whose EUS image showing a hypoechoic solid mass is a safe and accurate method. It should be taken into consideration in decision making, especially in early diagnosis and early treatment for this condition.