Current Surgical Endoscopy - Current Issue

Gastric cancer is prevalent in the Brazilian population, with diagnosis largely reliant on endoscopic biopsies. Current guidelines recommend a minimum of seven endoscopic biopsies. However, advances in high-definition imaging, chromoendoscopy technologies (such as narrow-band imaging [NBI]), and histopathological techniques suggest that fewer biopsies might suffice. Validating this hypothesis could reduce the duration of examinations, lessen the burden on pathologists, and minimize risks associated with multiple biopsies.

This prospective study evaluated the efficacy of various biopsy strategies in diagnosing gastric lesions. A total of 106 lesions from 104 patients were examined over 14 months. The study compared the diagnostic yield of the conventional seven biopsies (considered the gold standard) with a single white-light biopsy, one NBI-guided biopsy, and a combination of both white-light and NBI-guided biopsies.

When compared to the gold standard of seven biopsies, the single white-light biopsy demonstrated a sensitivity of 90.1% (range 82.5-95.6%) and a specificity of 100% (range 47.8-100%). The NBI-guided biopsy yielded a sensitivity of 83.2% (range 74.4-89.9%) and a specificity of 100% (range 47.8-100%). Combining both biopsy techniques achieved a sensitivity of 96.1% and a specificity of 100%.

A single white-light biopsy was found to be nearly equivalent to the gold standard of seven biopsies, using a 10% difference as the noninferiority criterion. Performing two biopsies-one conventional and one NBI-guided-provided even greater accuracy, closely approximating that of the gold standard.

Solid pseudopapillary tumors of the pancreas (SPN) are uncommon lesions. Endoscopic ultrasound is considered the standard examination because of its capability to acquire a suitable core tissue sample. This study details the experience of eleven cases within a Latin American population diagnosed with SPNs through the endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) approach.

Retrospective reviews of records from a 6-year period, from January 2018 to December 2023, were performed at Clínica Reina Sofía in Bogotá, Colombia. We included eleven patients with surgically proven solid pseudopapillary tumors who had undergone preoperative EUS−FNB. The clinical history, EUS findings, biopsies, and immunohistochemical profile were reviewed.

In this study of eleven SPN patients (median age: 31.9 years, 90.1% female, all Hispanic), abdominal pain (63.6%) was the predominant symptom. The indication for EUS was predominantly a pancreas-dependent mass (90.1%). Tumors were located more frequently on the pancreatic neck, with regular morphology, well-defined borders, and predominantly hypoechoic and heterogeneous appearances on EUS. The average tumor diameter was 4.3 cm [range 1.2- 10 cm]. Most tumors were solid (63.6%), and elastography revealed a mixed pattern. EUS-Doppler indicated hypovascularity in all cases. Vascular compression occurred in three patients. No lymph nodes were observed. There were no complications related to the procedure. The histopathological analysis using EUS-FNB yielded consistent results with post-surgical biopsies.

In the context of diagnostic evaluation for SPNs, EUS-FNB emerges as a pivotal procedure. In this descriptive study, EUS-FNB showed a remarkable preoperative diagnostic yield of 100% compared to post-surgical histopathology for solid pseudopapillary tumors.