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Advancements in the Diagnosis of Gastric Subepithelial Tumors

Iwakiri Katsuhiko|Goto Osamu|Kaise Mitsuru
거트앤리버 소화기연관학회협의회|2022.05|Gut and Liver|제16권 제3호|pp. 321-330|DOI 10.5009/gnl210242

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참고문헌

키워드

EndosonographyGastrointestinal stromal tumorSubepithelial tumor

초록

A diagnosis of subepithelial tumors (SETs) is sometimes difficult due to the existence of overlying mucosa on the lesions, which hampers optical diagnosis by conventional endoscopy and tissue sampling with standard biopsy forceps. Imaging modalities, by using computed tomography and endoscopic ultrasonography (EUS) are mandatory to noninvasively collect the target’s information and to opt candidates for further evaluation. Particularly, EUS is an indispensable diagnostic modality for assessing the lesions precisely and evaluating the possibility of malignancy. The diagnostic ability of EUS appears increased by the combined use of contrast-enhancement or elastography. Histology is the gold standard for obtaining the final diagnosis. Tissue sampling requires special techniques to break the mucosal barrier. Although EUS-guided fine-needle aspiration (EUS-FNA) is commonly applied, mucosal cutting biopsy and mucosal incision-assisted biopsy are comparable methods to definitively obtain tissues from the exposed surface of lesions and seem more useful than EUS-FNA for small SETs. Recent advancements in artificial intelligence (AI) have a potential to drastically change the diagnostic strategy for SETs. Development and establishment of noninvasive methods including AI-assisted diagnosis are expected to provide an alternative to invasive, histological diagnosis.

Abstract

A diagnosis of subepithelial tumors (SETs) is sometimes difficult due to the existence of overlying mucosa on the lesions, which hampers optical diagnosis by conventional endoscopy and tissue sampling with standard biopsy forceps. Imaging modalities, by using computed tomography and endoscopic ultrasonography (EUS) are mandatory to noninvasively collect the target’s information and to opt candidates for further evaluation. Particularly, EUS is an indispensable diagnostic modality for assessing the lesions precisely and evaluating the possibility of malignancy. The diagnostic ability of EUS appears increased by the combined use of contrast-enhancement or elastography. Histology is the gold standard for obtaining the final diagnosis. Tissue sampling requires special techniques to break the mucosal barrier. Although EUS-guided fine-needle aspiration (EUS-FNA) is commonly applied, mucosal cutting biopsy and mucosal incision-assisted biopsy are comparable methods to definitively obtain tissues from the exposed surface of lesions and seem more useful than EUS-FNA for small SETs. Recent advancements in artificial intelligence (AI) have a potential to drastically change the diagnostic strategy for SETs. Development and establishment of noninvasive methods including AI-assisted diagnosis are expected to provide an alternative to invasive, histological diagnosis.

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관련 논문AI추천

Advances in the Management of Upper Gastrointestinal Subepithelial Tumor: Pathologic Diagnosis Using Endoscopy without Endoscopic Ultrasound-Guided BiopsyHang Lak Lee대한소화기내시경학회 · Clinical Endoscopy2016 · 제49권 제3호Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions공은정, Do Hoon Kim대한소화기내시경학회 · Clinical Endoscopy2016 · 제49권 제5호Endoscopic Resection of Subepithelial Tumors김광하대한소화기내시경학회 · Clinical Endoscopy2012 · 제45권 제3호Current Status of Endoscopic Ultrasonography in Gastrointestinal Subepithelial TumorsJi Hyun Song, Joo Ha Hwang, Sang Gyun Kim대한소화기내시경학회 · Clinical Endoscopy2019 · 제52권 제4호Systematic Endoscopic Approach for Diagnosing Gastric Subepithelial Tumors김광하거트앤리버 소화기연관학회협의회 · Gut and Liver2022 · 제16권 제1호Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial TumorsDo Hoon Kim, Gyu Young Pih대한소화기내시경학회 · Clinical Endoscopy2019 · 제52권 제4호

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