Preoperative Diagnosis of Upper Gastrointestinal Leiomyoma by Endoscopic Ultrasound-guided Fine Needle Aspiration

Abstract

Aims: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) with using immunohistochemical analysis in the preoperative diagnosis of upper gastrointestinal leiomyoma. Study Design:  This was ’prospective’ observational study. Place and Duration of Study: Department of surgery №1, Vinnytsia National Pirogov Medical University, Vinnytsia, Ukraine; between September 2016 and February 2019. Methodology: Sixteen prospectively studies have been performed using endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in patients with submucosal hypoechoic tumors (according to the results of previous gastroduodenoscopy) with continuity to proper muscle layer suspected as leiomyoma of upper gastrointestinal tract. All cases for the final diagnosis underwent surgery (n = 16). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens have been compared. Results: The puncture has been performed in all patients without any anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 87, 5%. The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 77, 8%, 100% and 100% respectively. In 16 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of leiomyoma were 100%; 83,3%; 90,9%; 100% and 93,75% respectively. No major complications were encountered. Conclusion: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the preoperative diagnosis of gastrointestinal leiomyoma. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for gastrointestinal leiomyoma.