Indications de la ponction-biopsie à l’aiguille fine guidée sous écho-endoscopie (EUS FNA) dans les tumeurs sous-épithéliales
Indications of endoscopic ultrasonography-guided fine needle aspiration (EUS FNA) in subepithelial tumors
Subepithelial tumors of the gastrointestinal tract are uncommon. However, they often represent a managing challenge, mainly in asymptomatic patients in whom the lesion is found incidentally while the upper endoscopy is performed for any other reason or symptom not related to the tumor. This situation occurs in about 0.5 % of routine endoscopies .
The first problem once identified the bulge is the differential diagnosis with an extraluminal compression due to normal or pathological structures since its underlying nature cannot be elucidated by upper endoscopy alone. The second goal is to assess the morphological characteristics of the tumor attempting to ascertain its nature (since endoscopic biopsies are usually inconclusive due to the indemnity of the mucosa) and to exclude cystic lesions that usually require a conservative approach. Finally, a decision on management (surgery or surveillance) has to be taken.
This review is aimed at answering these questions and, mainly, to discuss the usefulness of obtaining a sample of the tumor in terms of impact on decision making and prognosis. However, the indication of EUS FNA in subepithelial tumors has probably to be taken in every single patient depending on the clinical situation, morphological characteristics of the tumor and impact of results on management. Since the majority of subepithelial tumors of the GI tract (except those in the esophagus and muscularis mucosae of the colon and rectum and other more uncommon GISTs, data of this review will mainly refer to them.
Angels GINÈS, Glòria FERNÀNDEZ-ESPARRACH, Maria PELLISÉ, M. SOLÉ
cytology, endoscopie ultrasonography (EUS), fine needle aspiration (FNA), GIST, subepithelial tumours