Endosonografi yapılan üst gastro intestinal intramural-submukozal lezyonların cerrahi ve iğne aspirasyon biyopsi verilerinin patolojik sonuçlar ile analizi: 6 yıllık değerlendirme
Öz
Amaç: Subepitelyal lezyonlar gastrointestinal sistemin tüm katmanlarından gelişebilmekte olup bu lezyonların tanısında endosonografi, lezyonun boyutu, sınırı, ekosu ile lenf nodu yakınlığının tespitinde gerekli olan tanısal bir yöntemdir. Çalışmamızda endosonografi (EUS) ile elde edilen görüntülemelerin, bu vakaların patolojik analizleri eşliğinde değerlendirilmesini ve patolojik sonuçlarla uyumunu incelemeyi amaçladık.
Gereç ve Yöntem: Çalışmamızda retrospektif olarak Gazi Üniversitesi Tıp Fakültesi Gastroenteroloji Bölümü’nde 2005-2011 yılları arasında EUS ile tespit edilen 36 adet üst gastrointestinal intramural-submukozal kitle lezyonu incelenmiştir. Patolojik değerlendirme yapılan vakaların ince iğne aspirasyon biyopsisi (İİAB) ve/veya cerrahi teknikler ile alınan patolojik verileri de derlenmiştir.
Bulgular: Otuz-altı adet submukozal kitle lezyonunun 12’sine (%33,3) İİAB ile, 13’ine (%36,1) cerrahi işlem ile patolojik tanı konulmuştur. Vakaların 22’si (%61,1) mide, 5’i (%13,9) duodenum, 9’u (%25) özofagus orijinli idi. Tüm EUS değerlendirmelerinde stromal ya da gastrointestinal stromal tümör (GIST) düşünülmüş olup 14 (%38,8) vakada bu sonuç patolojik olarak doğrulanmıştır. İİAB yapılan 2 vakada stromal tümör tanısı kesin, 2 vakada şüpheli olarak konulmuştur.
Sonuç: EUS üst gastrointestinal sistem intramural-submukozal kitle incelemesinde değerli bir yöntem olup İİAB’nin bu yönteme eklenmesi tanısal doğruluk açısından yüksek nitelikte destekleyici olarak rol oynamaktadır. Ülkemizde EUS ile saptanan submukozal kitle lezyonlarının en sık yerleşimi gastrik lokalizasyondadır ve bu bulgu uluslararası literatür verileri ile uyumludur
Anahtar Kelimeler
Kaynakça
- Kaynaklar
- Referans1-Hedenbro JL, Ekelund M, Wetterberg P.Endoscopic diagnosis of submucosal gastriclesions. The results after routine endoscopy. Surg Endosc. 1991;5:20–3. Referans2-Hwang JH, Saunders MD, Rulyak SJ, Shaw S, Nietsch H, Kimmey MB.A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses.Gastrointest Endosc. 2005 Aug;62(2):202-8. Referans3-MenonL, Buscaglia JM.Endoscopic approach to subepithelial lesions.Therap Adv Gastroenterol. 2014 May;7(3):123-30. Referans4-Polkowski, M. (2005) Endoscopicultrasoundandendoscopicultrasound-guidedfine-needlebiopsyforthediagnosis of malignantsubmucosaltumors. Endoscopy 37: 635–645. Referans 5-Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W.Accuracy of EUS in the evaluation of small gastric subepithelial lesions.Gastrointest Endosc. 2010 Apr;71(4):722-7. Referans 6-Rösch T, Kapfer B, Will U et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study.Scand J Gastroenterol. 2002 Jul;37(7):856-62. Referans 7-Ando N, Goto H, Niwa Y et al. The diagnosis of GI stromaltumorswith EUS-guided fine needle aspiration with immunohistochemical analysis.Gastrointest Endosc. 2002 Jan;55(1):37-43. Referans 8-Fu K, Eloubeidi MA, Jhala NC, Jhala D, Chhieng DC, Eltoum IE.Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy--a potential pitfall.Ann Diagn Pathol. 2002 Oct;6(5):294-301. Referans 9-Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB.Diagnosticproceduresforsubmucosaltumors in thegastrointestinaltract.World J Gastroenterol. 2007 Jun 28;13(24):3301-10. Referans 10-Oztas E, Oguz D, Kurt M et al. Endosonographic evaluation of patients with suspected extraluminal compression or subepithelial lesions during upper gastrointestinal endoscopy.Eur J GastroenterolHepatol. 2011 Jul;23(7):586-92. Referans 11-Chaves DM, Meine GC, Moura DT et al. Endoscopıc ultrasound in the evaluation of upper subepıthelial lesıons.Arq Gastroenterol. 2015 Jul-Sep;52(3):186-9.
Öz
Aim: Subepithelial lesions can be composed of all layers of the gastrointestinal tract and endosonography is a diagnostic
method that is necessary for diagnosis in determining the size limit echo structure and lymph node proximity
in these lesions. In our study, we aimed to evaluate the images obtained by EUS in the context of pathological
analyzes obtained later and to evaluate the compliance status.
Material and Method: In our study, 36 upper gastrointestinal submucosal mass lesions detected by EUS between
2005 and 2011 in Gazi University Fac of Med Gastroenterology Department were examined retrospectively.To
some of these lesions included fine needle aspiration biopsies and surgery material pathological data.
Results: Twelve (33.3%) of 36 submucosal mass lesions detected by endosonography were diagnosed histopathologically
by fine needle aspiration biopsy (FNA) and 13 (36.1) were diagnosed by surgery. 22 (61.1%) of the cases
were stomach, 5 (13.9%) were duodenum and 9 (25%) were of esophagus origin. Stromal or GIST tumors were
considered in 36 EUS evaluations and 14 (38.8%) were pathologically confirmed. The stromal tumor was confirmed
in 2 cases with FNA. The diagnosis of stromal tumors in 2 cases with FNA was predicted as suspicious.
Conclusion: Endosondography is a valuable method in the evaluation of upper gastrointestinal system submucosal
mass and the addition of fine needle aspiration biopsies to this method plays a supporting role in diagnostic quality
in terms of high quality. In our country, endosonographic dominant gastric upper gastrointestinal organ location of
submucosal mass lesions is consistent with international literature data.
Anahtar Kelimeler
Kaynakça
- Kaynaklar
- Referans1-Hedenbro JL, Ekelund M, Wetterberg P.Endoscopic diagnosis of submucosal gastriclesions. The results after routine endoscopy. Surg Endosc. 1991;5:20–3. Referans2-Hwang JH, Saunders MD, Rulyak SJ, Shaw S, Nietsch H, Kimmey MB.A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses.Gastrointest Endosc. 2005 Aug;62(2):202-8. Referans3-MenonL, Buscaglia JM.Endoscopic approach to subepithelial lesions.Therap Adv Gastroenterol. 2014 May;7(3):123-30. Referans4-Polkowski, M. (2005) Endoscopicultrasoundandendoscopicultrasound-guidedfine-needlebiopsyforthediagnosis of malignantsubmucosaltumors. Endoscopy 37: 635–645. Referans 5-Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W.Accuracy of EUS in the evaluation of small gastric subepithelial lesions.Gastrointest Endosc. 2010 Apr;71(4):722-7. Referans 6-Rösch T, Kapfer B, Will U et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study.Scand J Gastroenterol. 2002 Jul;37(7):856-62. Referans 7-Ando N, Goto H, Niwa Y et al. The diagnosis of GI stromaltumorswith EUS-guided fine needle aspiration with immunohistochemical analysis.Gastrointest Endosc. 2002 Jan;55(1):37-43. Referans 8-Fu K, Eloubeidi MA, Jhala NC, Jhala D, Chhieng DC, Eltoum IE.Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy--a potential pitfall.Ann Diagn Pathol. 2002 Oct;6(5):294-301. Referans 9-Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB.Diagnosticproceduresforsubmucosaltumors in thegastrointestinaltract.World J Gastroenterol. 2007 Jun 28;13(24):3301-10. Referans 10-Oztas E, Oguz D, Kurt M et al. Endosonographic evaluation of patients with suspected extraluminal compression or subepithelial lesions during upper gastrointestinal endoscopy.Eur J GastroenterolHepatol. 2011 Jul;23(7):586-92. Referans 11-Chaves DM, Meine GC, Moura DT et al. Endoscopıc ultrasound in the evaluation of upper subepıthelial lesıons.Arq Gastroenterol. 2015 Jul-Sep;52(3):186-9.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 10 Sayı: 4 |
e-ISSN: 2548-0251
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