Analysis of the amount of tissue sample necessary for mitotic count and Ki-67 index in gastrointestinal stromal tumor sampling

Kobara,Hideki; Mori,Hirohito; Rafiq,Kazi; Fujihara,Shintaro; Nishiyama,Noriko; Chiyo,Taiga; Matsunaga,Tae; Ayaki,Maki; Yachida,Tatsuo; Kato,Kiyohito; Kamada,Hideki; Fujita,Koji; Morishita,Asahiro; Oryu,Makoto; Tsutsui,Kunihiko; Iwama,Hisakazu; Kushida,Yoshio; Haba,Reiji; Masaki,Tsutomu

doi:10.3892/or.2014.3608

Analysis of the amount of tissue sample necessary for mitotic count and Ki-67 index in gastrointestinal stromal tumor sampling

Authors:
- Hideki Kobara
- Hirohito Mori
- Kazi Rafiq
- Shintaro Fujihara
- Noriko Nishiyama
- Taiga Chiyo
- Tae Matsunaga
- Maki Ayaki
- Tatsuo Yachida
- Kiyohito Kato
- Hideki Kamada
- Koji Fujita
- Asahiro Morishita
- Makoto Oryu
- Kunihiko Tsutsui
- Hisakazu Iwama
- Yoshio Kushida
- Reiji Haba
- Tsutomu Masaki
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Affiliations: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan, Department of Pharmacology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan, Life Science Research Center, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan, Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa 761-0793, Japan
Published online on: November 14, 2014 https://doi.org/10.3892/or.2014.3608
Pages: 215-222

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Abstract

There are no established opinions concerning whether the amount of tissue affects the accuracy of histological analyses in gastrointestinal stromal tumors (GISTs). The aim of the present study was to investigate the appropriate amount of tissue sample needed for mitotic count based on the risk classification of GISTs and the Ki-67 index using the following three methods: endoscopic ultrasound-guided fine-needle aspiration (FNA), a novel sampling method called tunneling bloc biopsy (TBB), and biopsy forceps followed by TBB (Bf). Forty-three samples (12 FNA, 17 TBB and 14 Bf) diagnosed as GISTs by immunohistological analysis were utilized. The major and minor axes and overlay area of one piece of specimen (OPS) from the three sampling methods were measured using digital imaging software and were analyzed comparatively regarding the acquisition of histological data. The mean major and minor axes (mm) and overlay areas (mm2) were in the order of TBB > Bf > FNA. The evaluable rates by mitotic count and Ki-67 were, respectively, 75% (9/12) and 83.3% (10/12) for FNA samples, 100% (17/17) and 100% (17/17) for TBB samples, and 100% (14/14) and 100% (14/14) for Bf samples (P>0.05). Three FNA samples were judged unevaluable due to too small specimens in overall diagnosis including mitotic count and Ki-67, calculating the cut-off value for the overlay area of OPS as 0.17 mm2. Comparing the concordance rates between the pre- and post-operative samples, TBB samples was significantly better than FNA (P<0.05). Conclusively, while the amounts of tissues obtained by TBB and Bf are unnecessary for the histological assessment of mitotic count and Ki-67 index, developments of the FNA method are needed to minimize sample error. Considering the technical aspects, as well as the size of the specimens, could help to guide therapeutic planning and improve diagnostic yield for GI subepithelial tumors.

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1	Hwang JH and Kimmey MB: The incidental upper gastrointestinal subepithelial mass. Gastroenterology. 126:301–307. 2004. View Article : Google Scholar
2	Blay JY, Bonvalot S, Casali P, et al: Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol. 16:566–578. 2005. View Article : Google Scholar : PubMed/NCBI
3	Mori H, Kobara H, Kobayashi M, et al: Establishment of pure NOTES procedure using a conventional flexible endoscope: review of six cases of gastric gastrointestinal stromal tumors. Endoscopy. 43:631–634. 2011. View Article : Google Scholar : PubMed/NCBI
4	Demetri GD, Benjamin RS, Blanke CD, et al: NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST) - update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 5(Suppl 2): S1–S29. 2007.
5	National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma Version 2. National Comprehensive Cancer Network; Fort Washington, PA: 2009
6	Casali PG, Jost L, Reichardt P, Schlemmer M and Blay JY; ESMO Guidelines Working Group. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 20(Suppl 4): S64–S67. 2009.
7	Blackstein ME, Blay JY, Corless C, et al: Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol. 20:157–163. 2006.PubMed/NCBI
8	Nishida T, Hirota S, Yanagisawa A, et al: Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol. 13:416–430. 2008. View Article : Google Scholar : PubMed/NCBI
9	Fletcher CD, Berman JJ, Corless C, et al: Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 33:459–465. 2002. View Article : Google Scholar : PubMed/NCBI
10	Stelow EB, Stanley MW, Mallery S, Lai R, Linzie BM and Bardales RH: Endoscopic ultrasound-guided fine-needle aspiration findings of gastrointestinal leiomyomas and gastrointestinal stromal tumors. Am J Clin Pathol. 119:703–708. 2003. View Article : Google Scholar : PubMed/NCBI
11	Ando N, Goto H, Niwa Y, et al: The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc. 55:37–43. 2002. View Article : Google Scholar : PubMed/NCBI
12	Sepe PS, Moparty B, Pitman MB, et al: EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc. 70:254–261. 2009. View Article : Google Scholar : PubMed/NCBI
13	Hoda KM, Rodriguez SA and Faigel DO: EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc. 69:1218–1223. 2009. View Article : Google Scholar : PubMed/NCBI
14	Mekky MA, Yamao K, Sawaki A, et al: Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc. 71:913–919. 2010. View Article : Google Scholar : PubMed/NCBI
15	Sumiyama K, Gostout CJ, Rajan E, et al: Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc. 65:688–694. 2007. View Article : Google Scholar : PubMed/NCBI
16	Kobara H, Mori H, Fujihara S, et al: Bloc biopsy by using submucosal endoscopy with a mucosal flap method for gastric subepithelial tumor tissue sampling (with video). Gastrointest Endosc. 77:141–145. 2013. View Article : Google Scholar
17	Lai R, Stanley MW, Bardales R, Linzie B and Mallery S: Endoscopic ultrasound-guided pancreatic duct aspiration: diagnostic yield and safety. Endoscopy. 34:715–720. 2002. View Article : Google Scholar : PubMed/NCBI
18	Miettinen M and Lasota J: Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 23:70–83. 2006. View Article : Google Scholar : PubMed/NCBI
19	Sakamoto H, Kitano M, Komaki T, et al: Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol. 24:384–390. 2009. View Article : Google Scholar
20	Polkowski M, Gerke W, Jarosz D, et al: Diagnostic yield and safety of endoscopic ultrasound-guided trucut biopsy in patients with gastric submucosal tumors: a prospective study. Endoscopy. 41:329–334. 2009. View Article : Google Scholar : PubMed/NCBI
21	Fu K, Eloubeidi MA, Jhala NC, Jhala D, Chhieng DC and Eltoum IE: Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy - a potential pitfall. Ann Diagn Pathol. 6:294–301. 2002. View Article : Google Scholar : PubMed/NCBI
22	Fernández-Esparrach G, Sendino O, Solé M, et al: Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy. 42:292–299. 2010. View Article : Google Scholar : PubMed/NCBI
23	Kobara H, Mori H, Rafiq K, et al: Submucosal tunneling techniques: current perspectives. Clin Exp Gastroenterol. 7:67–74. 2014. View Article : Google Scholar : PubMed/NCBI