Background. For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degre e of malignancy, and EUS-guided fine-needle aspiration bio...Background. For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degre e of malignancy, and EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been reported to be more useful. Recently, most cases initially diagnosed as lei omyosarcomas have received further study with immunohistochemical staining and h ave been given the new diagnosis of gastrointestinal stromal tumors (GISTs). The degree of malignancy of GISTs differs widely in clinical aspects. In this study , we examined whether EUS-FNAB was useful in diagnosing GISTs and differentiati ng their degrees of malignancy. Methods. From January 1997 to March 2002,21 case s of gastric GISTs were diagnosed from the immunohistochemical staining of speci mens resected at Aichi Cancer Center Hospital. Of these 21 patients, 14 (5 with high-grade malignancy and 9 with lowgrade malignancy) underwent EUS-FNAB preop eratively, and were examined further: their EUS-FNAB specimens were submitted f or additional immunohistochemical testing. Results. The EUS-FNAB specimens from all patients were positive for c-kit and CD34 immunohistochemical testing, coi nciding with the staining results of the resected specimens. The MIB-1 labeling indic es in specimens of high-grade malignancy were significantly higher than those o f low-grade malignancy. If we assumed that a tumor with an MIB-1 labeling inde x of more than 5%was a high-grade malignancy, the diagnostic, accuracy was 85. 7%. Conclusions. The EUS-FNAB procedure is a useful tool for diagnosing GISTs of the stomach with immunohistochemical staining. When used with MIB-1 staining , the proceduremay indicateGIST prognosis and influence decisions regarding ther apeutic strategies.展开更多
Despite advances in diagnostic imaging techniques, the differentiation between pancreatic cancer and focal pancreatitis remains difficult. This study evaluated the effectiveness of EUS-guided FNA in the differential d...Despite advances in diagnostic imaging techniques, the differentiation between pancreatic cancer and focal pancreatitis remains difficult. This study evaluated the effectiveness of EUS-guided FNA in the differential diagnosis between pancreatic cancer and focal pancreatitis, with particular reference to detection of the K-ras point mutation. The study included 62 consecutive patients with pancreatic ductal cancer and 15 patients with focal pancreatitis demonstrated as a pancreatic mass lesion by EUS. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of cytopathologic diagnosis were 82%, 100%, 86%, 100%, and 58%, respectively. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of histopathologic diagnosis were 44%, 100%, 55%, 100%, and 32%, respectively. The K-ras point mutation was found in 74%of pancreatic cancers and 0%of focal pancreatitis lesions. No complication of EUS-guided FNA was observed. EUS-guided FNA is useful for the differential diagnosis of pancreatic mass lesions caused by pancreatic cancer and focal pancreatitis. Analysis for the K-ras point mutation in specimens obtained by EUS-guided FNA may enhance diagnostic accuracy in indeterminate cases.展开更多
文摘Background. For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degre e of malignancy, and EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been reported to be more useful. Recently, most cases initially diagnosed as lei omyosarcomas have received further study with immunohistochemical staining and h ave been given the new diagnosis of gastrointestinal stromal tumors (GISTs). The degree of malignancy of GISTs differs widely in clinical aspects. In this study , we examined whether EUS-FNAB was useful in diagnosing GISTs and differentiati ng their degrees of malignancy. Methods. From January 1997 to March 2002,21 case s of gastric GISTs were diagnosed from the immunohistochemical staining of speci mens resected at Aichi Cancer Center Hospital. Of these 21 patients, 14 (5 with high-grade malignancy and 9 with lowgrade malignancy) underwent EUS-FNAB preop eratively, and were examined further: their EUS-FNAB specimens were submitted f or additional immunohistochemical testing. Results. The EUS-FNAB specimens from all patients were positive for c-kit and CD34 immunohistochemical testing, coi nciding with the staining results of the resected specimens. The MIB-1 labeling indic es in specimens of high-grade malignancy were significantly higher than those o f low-grade malignancy. If we assumed that a tumor with an MIB-1 labeling inde x of more than 5%was a high-grade malignancy, the diagnostic, accuracy was 85. 7%. Conclusions. The EUS-FNAB procedure is a useful tool for diagnosing GISTs of the stomach with immunohistochemical staining. When used with MIB-1 staining , the proceduremay indicateGIST prognosis and influence decisions regarding ther apeutic strategies.
文摘Despite advances in diagnostic imaging techniques, the differentiation between pancreatic cancer and focal pancreatitis remains difficult. This study evaluated the effectiveness of EUS-guided FNA in the differential diagnosis between pancreatic cancer and focal pancreatitis, with particular reference to detection of the K-ras point mutation. The study included 62 consecutive patients with pancreatic ductal cancer and 15 patients with focal pancreatitis demonstrated as a pancreatic mass lesion by EUS. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of cytopathologic diagnosis were 82%, 100%, 86%, 100%, and 58%, respectively. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of histopathologic diagnosis were 44%, 100%, 55%, 100%, and 32%, respectively. The K-ras point mutation was found in 74%of pancreatic cancers and 0%of focal pancreatitis lesions. No complication of EUS-guided FNA was observed. EUS-guided FNA is useful for the differential diagnosis of pancreatic mass lesions caused by pancreatic cancer and focal pancreatitis. Analysis for the K-ras point mutation in specimens obtained by EUS-guided FNA may enhance diagnostic accuracy in indeterminate cases.
