Endoscopic ultrasound-guided fine-needle aspiration used in diagnosing gastric linitis plastica: Metastatic lymph nodes can be valuable targets

摘要

Background and Aim The aim of this study was to assess the performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of gastric linitis plastic (GLP). Methods We retrospectively reviewed all the cases undergoing EUS for suspected GLP from January 2012 to September 2017. We included patients with GLP confirmed pathologically with white-light endoscopy (WLE)-guided biopsy or EUS-FNA. Diagnostic value of WLE biopsy and EUS-FNA was further analyzed. Results A total of 107 cases of suspected GLP were referred for EUS examination in our center. Twenty-six patients were eligible and included. GLP was confirmed in 15 cases by EUS-FNA, nine cases by WLE biopsy, and eight cases by surgical pathology. The positive rate of EUS-FNA and WLE biopsy for involved gastric wall was 71.43% (15/21) and 47.37% (9/19). EUS-FNA of metastatic lymph nodes was also performed in 16 cases, and 15 (93.75%) were proved to be malignant, including all 13 that were positive for peri-gastric lymph nodes, and two of three (66.67%) that were positive rate for retroperitoneal lymph nodes. Diameters of punctured lymph nodes ranged from 3.30 to 22.70 mm, with an average of 12.12 mm. Conclusions Pathological diagnosis of GLP by invasive endoscopy is still intractable, even at a late stage. Positive results can be obtained even in small or distant lymph nodes.