The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis
The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis
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DOI：
10.1067/mge.2002.120323
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发表时间：
2002-01-01
影响因子：
7.7
通讯作者：
Hayakawa, T
中科院分区：
文献类型：
--
作者：
Ando, N;Goto, H;Hayakawa, T
背景：随着免疫组织化学分析的出现，术语“胃肠道间质瘤”（GIST）被提出来指定原发性非上皮肿瘤的最大类别。 EUS 引导细针抽吸 (EUS-FNA) 对于诊断 GIST 非常有用。本研究的目的是通过使用 EUS-FNA 和免疫组织化学分析来评估 GIST 的表型和恶性 GIST 的诊断。方法：采用 EUS-FNA 结合免疫组化分析对 23 例 GIST 进行诊断。与单独的 EUS 成像相比，分析了 EUS-FNA 诊断的准确性。此外，还对通过 EUS-FNA 获得的标本和手术切除标本的免疫表型进行了比较。还分析了恶性 GIST 的诊断因素。结果：仅通过 EUS 成像诊断恶性 GIST 的总体准确率为 78% (18/23)，通过 EUS-FNA 获取的标本进行组织病理学评估（H&E 染色）诊断恶性 GIST 的总体准确率为 91% (21/23)。 23 例中有 21 例 (91%) FNA 和手术标本中 c-kit、CD34、肌肉肌动蛋白和 S-100 的免疫组织化学表达一致。 FNA 标本的有丝分裂细胞 (p = 0.011) 和 Ki-67 标记指数 (p < 0.0001) 是恶性 GIST 的重要预测因素。对于恶性GIST的诊断，EUS-FNA加Ki-67免疫组化染色的准确性、敏感性和特异性均为100%。结论。 EUS-FNA 结合免疫组织化学分析有助于 GIST 的术前诊断。它提供了有关免疫组织化学亚型和肿瘤细胞进展能力的丰富信息。
Background: With the advent of immunohistochemical analysis, the term "gastrointestinal stromal tumor" (GIST) was proposed to designate the largest category of primary nonepithelial neoplasms. EUS-guided fine needle aspiration (EUS-FNA) is useful for diagnosis of GISTs. The aim of this study was to evaluate the phenotyping of GISTs and diagnosis of malignant GISTs by using EUS-FNA with immunohistochemical analysis. Methods: A diagnosis of GIST was made in 23 patients by using EUS-FNA with immunohistochemical analysis. The accuracy of EUS-FNA diagnosis compared with the EUS imaging alone was analyzed. Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens was compared. Factors that were diagnostic for malignant GISTs were also analyzed. Results: The overall accuracy for the diagnosis of malignant GIST was 78% (18/23) by EUS imaging alone and 91% (21/23) by histopathologic evaluation (H&E staining) of specimens obtained by EUS-FNA. In 21 of 23 cases (91%) the immunohistochemical expressions of c-kit, CD34, muscle actin, and S-100 coincided for the FNA and surgical specimens. The presence of mitotic cells (p = 0.011) and the Ki-67 labeling Index (p < 0.0001) with respect to the FNA specimens were significant predictive factors for malignant GIST. For the diagnosis of malignant GIST, the accuracy, sensitivity, and specificity of EUS-FNA with the addition of Ki-67 immunohistochemical staining were 100%. Conclusions. EUS-FNA with immunohistochemical analysis is useful in the preoperative diagnosis of GIST. It provides abundant information on immunohistochemical subtyping and on the capacity of the tumor for cellular progression.