Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Research Article Volume 6 Issue 5

Diagnostic Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) Biopsy in Evaluating Primary and Metastatic Gastrointestinal Stromal Tumors (GIST)

Omer Waqas1*, Muhammed Aasim Yusuf2, Muhammad Asghar3, Asif Loya1 and Noreen Akhter1

1Departments of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan

2Internal Medicine and Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan

3Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan

*Corresponding Author: Omer Waqas, Departments of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.

Received: March 06, 2023; Published: April 17, 2023


Introduction: GIST is the most common gastric mesenchymal tumour and is diagnosed on the basis of a combination of clinical and radiological features, with biopsy being considered the gold standard. EUS-guided FNA is a minimally invasive procedure which, in combination with rapid on site evaluation or ROSE, is increasingly being utilized to diagnose lesions within and around the gastro-intestinal tract, and of the pancreas. In this study we aim to evaluate our experience in patients who were diagnosed with GIST on EUS-FNA.

Material and Methods: Thirteen patients [7 males, mean age 52 years] diagnosed with primary or metastatic GIST were diagnosed on EUS-FNA from January 2005 to June 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan were included in the study. Lesions were assessed using an Olympus linear array echo-endoscope. In each case part of the sampled material obtained using a 22-gauge EUS-FNA needle was smeared on glass slides, air-dried and then stained with Diff-Quik® stain for ROSE. One glass slide with smear was immediately dropped in 95% alcohol for Papanicolaou stain and the rest of the specimen was submitted for cell block in CytoLyt®. A trained cytopathologist was present in the procedure room for ROSE on Diff-Quik® stained slides. All slides and cell blocks were thoroughly examined and immunohistochemical (IHC) stains (CD117, DOG1, S100, Desmin and CK) were performed on the cell block material.

Results: The average size of the primary tumor in this study was 66.4 mm (range 30-120 mm) while metastatic tumors measured 15 mm each. Twelve tumours showed spindle cell morphology with only one mixed type. Mitoses were less than 5/10 HPF and no necrosis was seen. CD117 and DOG 1 were expressed in all thirteen cases.

Conclusion: Combining ROSE and IHC on cell-block material plays a vital role in confirming the diagnosis in both primary and metastatic GIST. Radiological findings can aid in risk assessment by documenting size and site. The diagnosis of GIST can be made confidently using EUS-FNA, even in resource-constraint settings.



  1. Wiersema MJ and Levy MJ. “Endosonography-Guided Fine Needle Aspiration Biopsy”. Handbook of Gastroenterologic Procedures (2005): 357.
  2. Levy MJ., et al. “Preliminary experience with an EUS-guided trucut biopsy needle compared with EUS-guided FNA”. Gastrointestinal Endoscopy1 (2003): 101-106.
  3. Fernández-Esparrach G., et al. “Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumours: a randomized crossover study”. Endoscopy 42 (2010): 292-299.
  4. Sumiyama K., et al. “Transesophageal mediastinoscopy by submucosal endoscopy with mucosal flap safety valve technique”. Gastrointestinal Endoscopy4 (2007): 679-683.
  5. Ieni A., et al. “Cytohistological and immunohistochemical characteristics of spindle-shaped mesenchymal neoplasms occurring in the gastrointestinal tract”. Scandinavian Journal of Gastroenterology3 (2017): 291-299.
  6. Miettinen M and Lasota J. “Gastrointestinal stromal tumours: pathology and prognosis at different sites”. In Seminars in Diagnostic Pathology 23.2 (2006): 70-83.
  7. Ito H., et al. “Fine-needle aspiration biopsy and endoscopic ultrasound for pretreatment pathological diagnosis of gastric gastrointestinal stromal tumours”. Gastroenterology Research and Practice (2012).
  8. Miettinen M and Lasota J. “Gastrointestinal stromal tumours: review on morphology, molecular pathology, prognosis, and differential diagnosis”. Archives of Pathology and Laboratory Medicine10 (2006): 1466-1478.
  9. Kindblom LG., et al. “Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumours show phenotypic characteristics of the interstitial cells of Cajal”. The American Journal of Pathology5 (1998): 1259.
  10. Tang YL., et al. “Discovered on gastrointestinal stromal tumours 1 (DOG1) expression in non‐gastrointestinal stromal tumour (non‐GIST) neoplasms”. Histopathology 5 (2014): 724-726.
  11. Nilsson B., et al. “Gastrointestinal stromal tumours: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era”. Cancer4 (2005): 821-829.
  12. Oliveira RP., et al. “Comparative study of the different degrees of risk of gastrointestinal stromal tumor”. Revista do Colégio Brasileiro de Cirurgiões 1 (2015): 32-36.
  13. Demetri GD., et al. “Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumours”. New England Journal of Medicine7 (2002): 472-480.
  14. Miettinen M and Lasota J. “Gastrointestinal stromal tumours (GISTs): definition, occurrence, pathology, differential diagnosis and molecular genetics”. Polish Journal of Pathology1 (2003): 3-24.
  15. Lee JR., et al. “Gastrointestinal autonomic nerve tumor: immunohistochemical and molecular identity with gastrointestinal stromal tumor”. The American Journal of Surgical Pathology8 (2001): 979-987.
  16. Blanke CD and Corless CL. “State-of-the art therapy for gastrointestinal stromal tumours”. Cancer Investigation 3 (2005): 274-280.
  17. Van Oosterom AT., et al. “European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. Safety and efficacy of imatinib (STI571) in metastatic gastrointestinal stromal tumours: a phase I study”. Lancet9291 (2001): 1421-1423.
  18. Tharian B., et al. “Endoscopic ultrasound fine needle aspiration: Technique and applications in clinical practice”. World Journal of Gastrointestinal Endoscopy12 (2012): 532.
  19. Imazu H., et al. “A prospective comparison of EUS-guided FNA using 25-gauge and 22-gauge needles”. Gastroenterology Research and Practice (2009).
  20. Larghi A., et al. “EUS-guided trucut needle biopsies in patients with solid pancreatic masses: a prospective study”. Gastrointestinal Endoscopy2 (2004): 185-190.
  21. Boggino HE., et al. “Cytomorphology of gastrointestinal stromal tumor: diagnostic role of aspiration cytology, core biopsy, and immunochemistry”. Diagnostic Cytopathology3 (2000): 156-160.
  22. Tamura T., et al. “Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumours”. Clinical Endoscopy (2017).
  23. Erickson RA., et al. “Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies”. Gastrointestinal Endoscopy2 (2000): 184-190.
  24. Hikichi T., et al. “Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists”. Journal of Gastroenterology4 (2009): 322-328.
  25. Hayashi T., et al. “Rapid on‐site evaluation by endosonographer during endoscopic ultrasound‐guided fine needle aspiration for pancreatic solid masses”. Journal of Gastroenterology and Hepatology4 (2013): 656-663.
  26. Klapman JB., et al. “Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration”. The American Journal of Gastroenterology6 (2003): 1289-1294.
  27. LeBlanc JK., et al. “Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis”. Gastrointestinal Endoscopy4 (2004): 475-481.
  28. Erozan YS. “Endoscopic Ultrasound–Guided Fine Needle Aspiration”. Acta Cytologica6 (1997): 1645-1646.
  29. Chatzipantelis P., et al. “Endoscopic ultrasound-guided fine needle aspiration biopsy in the diagnosis of gastrointestinal stromal tumours of the stomach. A study of 17 cases”. Journal of Gastrointestinal and Liver Diseases1 (2008): 15.
  30. Gu M., et al. “Cytologic diagnosis of gastrointestinal stromal tumours of the stomach by endoscopic ultrasound‐guided fine‐needle aspiration biopsy: Cytomorphologic and immunohistochemical study of 12 cases”. Diagnostic Cytopathology6 (2001): 343-350.
  31. Tamura T., et al. “Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumours”. Clinical Endoscopy (2017).
  32. Chang KJ and Wiersema MJ. “Endoscopic ultrasound-guided fine-needle aspiration biopsy and interventional endoscopic ultrasonography. Emerging technologies”. Gastrointestinal Endoscopy Clinics of North America 2 (1997): 221-235.
  33. Seidal T and Edvardsson H. “Diagnosis of gastrointestinal stromal tumor by fine‐needle aspiration biopsy: A cytological and immunocytochemical study”. Diagnostic Cytopathology 6 (2000): 397-401.
  34. Dodd LG., et al. “Fine-needle aspiration of gastrointestinal stromal tumours”. American Journal of Clinical Pathology 4 (1998): 439-443.
  35. Miettinen M., et al. “Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117 (KIT)”. Modern Pathology10 (2000): 1134-1142.
  36. Mehmood S., et al. “Onsite cytopathology evaluation and ancillary studies beneficial in EUS‐FNA of pancreatic, mediastinal, intra‐abdominal, and submucosal lesions”. Diagnostic Cytopathology4 (2015): 278-286.
  37. Mehmood S., et al. “Clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of mediastinal and intra-abdominal lymphadenopathy”. Acta Cytologica5 (2013): 436-442.
  38. Schmidt RL., et al. “The influence of rapid onsite evaluation on the adequacy rate of fine-needle aspiration cytology: a systematic review and meta-analysis”. American Journal of Clinical Pathology3 (2013): 300-308.
  39. Eloubeidi MA., et al. “Agreement between rapid onsite and final cytologic interpretations of EUS-guided FNA specimens: implications for the endosonographer and patient management”. The American Journal of Gastroenterology12 (2006): 2841-2847.


Citation: Omer Waqas., et al. “Diagnostic Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) Biopsy in Evaluating Primary and Metastatic Gastrointestinal Stromal Tumors (GIST)". Acta Scientific Gastrointestinal Disorders 6.5 (2023): 23-31.


Copyright: © 2023 Omer Waqas., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate35%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US