Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition and Histomorphologic Analysis for Suspected Spindle Cell Neoplasms of the Upper Gastrointestinal Tract: Does the Needle Size and Type Matter?

Background: The diagnosis of suspected spindle cell neoplasms (SCNs) of the upper gastrointestinal (GI) tract by fine needle aspiration (FNA) is challenging. Of late, various specially designed fine needle biopsy (FNB) needles have become available for better tissue acquisition and histomorphological analysis. We described here our experience of tissue acquisition and adequacy for histomorphologic analysis and immunohistochemistry by using a multilayer coil sheath nitinol-based FNA needle with Menghini tip.

Methods: This was a retrospective analysis of 14 patients of suspected upper gastrointestinal tract spindle cell neoplasms of which 8 patients had exophytic lesions arising from the gastric body, 3 arising from paraduodenal location, 1 from pancreato-duodenal groove area, 1 from left lobe of liver and 1 from pancreatic head. After initial evaluation by computed tomography (CT) scan and esophagogastroduodenoscopy, all patients underwent EUS evaluation including both cytology and FNB by using the nitinol-based FNA needle of EZ Shot 3 Plus (Olympus, Tokyo, Japan).

Results: Tissue acquisition was adequate for histomorphology and immunohistochemistry analysis in 13 patients (93%). A definite diagnosis of GIST was established in 9 patients, malignant GIST in 1, leiomyosarcoma in 1, inflammatory myofibroblast tumor in 1, and paraganglioma in 1. One patient with preoperative diagnosis of SPEN on EUS-FNA was found to have GIST on resected specimen. Eight patients with GIST including the one with malignant GIST received multikinase inhibitors as cytoreductive therapy.

Conclusion: Using the new FNA needle with modifications such as using nitinol instead of conventional stainless steel and multicoiling sheath, the tissue acquisition rate and diagnosis in suspected SCN of upper gastrointestinal tract was increased. In addition, its relatively lower price makes it convenient to be used in resource-limited settings as well.

S. No.	Age/sex	Site of lesion	FNA needle used	Tissue adequacy (morphology and IHC)	Diagnosis	Surgery	Final diagnosis (resected specimen)
1	65/M	Gastric body (exophytic)	19G	Yes	Malignant GIST	No (on Sorafenib)
2	53/M	Gastric body (exophytic)	22G	Yes	GIST	Excision	GIST
3	65/F	Duodenum (exophytic)	22G	Yes	Leiomyosarcoma	Excision	Leiomyosarcoma
4	28/M	Gastric body (exophytic)	22G	Yes	GIST	Excision	GIST
5	22/F	Duodenum (exophytic)	22G	Yes	Paraganglioma	Excision	Paraganglioma
6	68/F	Gastric body (exophytic)	22G	Yes	GIST	Planned
7	62/M	Left lobe of liver	22G	Yes	GIST	Resection	GIST
8	54/M	Gastric body (exophytic)	22G	Yes	GIST	Planned (on Imatinib)
9	53/M	Pancreato-duodenal groove	22G	Yes	Inflammatory myofibroblastic tumor	Planned
10	29/F	Gastric body (exophytic)	19G	Yes	GIST	Excision	GIST
11	14/F	Pancreatic head	22G		SPEN	Resection	GIST
12	56/M	Gastric body (exophytic)	19G	Yes	CKIT −ve GIST	Planned (on Imatinib)
13	49/M	Paraduodenal	19G	Yes	GIST	Planned (on Imatinib)
14	35/M	Gastric body (exophytic)	19G	Yes	GIST	Planned (on Imatinib)

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
22 April 2024