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The Pathologic Diagnosis of Subepithelial Lesions of the GI Tract Based Solely on Sonographic Features Correlates Poorly With Histopathological Diagnosis Obtained by Mucosal Resection
Andrew Jatskiv*1, Gabriel H. Lee1, Laura Rosenkranz1, Sandeep Patel1, Kenneth Sirinek2
1Medicine, UTHSCSA, San Antonio, TX; 2Surgery, UTHSCSA, San Antonio, TX
BACKGROUND
Subepithelial lesions are incidentally found during routine endoscopy of the gastrointestinal (GI) tract. Endoscopic ultrasonography (EUS) has become the preferred non-invasive technique in evaluating these subepithelial lesions. It is assumed that it provides valuable information such as size, echotexture, layer of origin and features of invasion which may correlate with a particular histopathological diagnosis. Available published data seems to indicate that there is an incongruency between sonographic diagnosis and the actual surgical pathology of gastric subepithelial lesions with a reported accuracy that ranges between 20% and 84%.
AIM
To compare the diagnosis suggested by sonographic evaluation of various subepithelial lesions throughout the GI tract with the histological description of tissue specimens obtained by endoscopic mucosal resection (EMR).
METHODS
Patients who underwent endoscopic mucosal resection for a suspected subepithelial lesion were retrospectively identified from 2009 to 2012 at two university hospitals. The diagnosis made at the time of the endoscopic ultrasound prior to EMR was compared with the diagnosis made from the specimen obtained after EMR.
RESULTS
Twenty-three patients (12M, 11F) with a mean age of 58yrs (range 36 -82 yrs) were identified who underwent both EUS and EMR for subepithelial lesions of the GI tract. The location of the lesions were: esophagus 1, stomach 13, duodenum 6, rectum 3. EUS based diagnosis was only 61% accurate when compared with the histopathological diagnosis obtained via EMR. (Table 1)
CONCLUSION
Except for the rectum, there is poor correlation between the sonographic and histopathological diagnosis of subepithelial lesions of the GI Tract. Based on these findings, clinical decision making protocols that rely solely on endoscopic sonographic findings for pathologic diagnosis are flawed and may lead to unnecessary surgical procedures. All subepithelial lesions of the GI Tract should undergo endoscopic mucosal resection for a definitive histopathological diagnosis to direct appropriate treatment.
| EUS Diagnosis | Histologic Diagnosis | Age | Sex | | Esophagus (1) | Duplication Cyst | Granular Cell Tumor | 36 | F | | | | | | | Stomach (13) | Carcinoid | Carcinoid | 48 | F | | Carcinoid | Carcinoid | 82 | F | | Carcinoid | Carcinoid | 59 | M | | Carcinoid | Carcinoid | 60 | M | | Carcinoid | Oxyntic Gastric Mucosa | 46 | F | | Carcinoid | Gastric Adenoma | 55 | M | | Granular Cell Tumor | Granular Cell Tumor | 61 | M | | Granular Cell Tumor | Pancreatic Heterotopia | 54 | M | | Granular Cell Tumor | Lipoma | 81 | F | | Inflammatory nodule | Inflammatory nodule | 63 | F | | Pancreatic Heterotopia | GIST | 63 | F | | Pancreatic Heterotopia | Pancreatic Heterotopia | 44 | F | | Pancreatic heterotopia | Pancreatic Heterotopia | 71 | M | | | | | | | Duodenum (6) | Pancreatic Heterotopia | Carcinoid | 44 | F | | Carcinoid | Carcinoid | 75 | M | | GIST | Leiomyoma | 58 | M | | Inflammatory nodule | Ectopic Salivary gland tissue | 52 | F | | Inflammatory nodule | Inflammatory nodule | 54 | M | | Carcinoid | Carcinoid | 51 | M | | | | | | | Rectum (3) | Inflammatory nodule | Inflammatory nodule | 73 | M | | Carcinoid | Carcinoid | 47 | F | | GIST | GIST | 61 | M |
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