Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Gastric Subepithelial Tumors Located in the Cardia

  • Ga Hee Kim
  • Ji Yong AhnEmail author
  • Chung Sik Gong
  • Mimi Kim
  • Hee Kyong Na
  • Jeong Hoon Lee
  • Kee Wook Jung
  • Do Hoon Kim
  • Kee Don Choi
  • Ho June Song
  • Gin Hyug Lee
  • Hwoon-Yong Jung
Original Article



In cases of subepithelial tumors (SETs) located in the cardiac area, a preoperative histologic diagnosis might be helpful in determining the requirement of surgery.


To investigate the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in gastric SETs located in the cardia.


The data of 107 patients who underwent EUS-FNB, from 2012 to 2017, for tissue sampling of gastric SETs located in the cardia were collected. The clinicopathological data, EUS-related parameters, and surgical outcomes were retrospectively reviewed.


The EUS-FNB results were diagnostic in 86.9% (93/107) and nondiagnostic in 13.1% (14/107) of the patients. Immunostaining of the FNB specimens led to the diagnosis of gastrointestinal stromal tumor (GIST) in 25 SETs (23.4%), leiomyoma in 62 SETs (57.9%), heterotopic pancreas in 3 SETs (2.8%), and schwannoma in 2 SETs (1.9%). In the multivariate analysis, patients with GISTs showed significantly more inhomogeneous echogenicity [odds ratio (OR), 8.867], more cystic foci (OR, 26.98), and older age (OR, 1.087). In 26 patients who underwent surgical resection, the agreement between EUS-FNB and surgical pathological findings was 100% with respect to the diagnosis of GISTs (n = 20) and leiomyoma (n = 7). Among these cases, the proportion of high-risk GISTs was 20.0% (4/20), and no leiomyosarcoma was detected.


Although a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.


Endoscopic ultrasound-guided fine-needle aspiration Cardia Gastrointestinal stromal tumors Stomach 


Author’s contribution

Ga Hee Kim and Ji Yong Ahn designed the study; Kee Don Choi analyzed the raw data and performed statistical analyses; Mimi Kim, Hee Kyong Na, Do Hoon Kim, Jeong Hoon Lee, and Hwoon-Yong Jung contributed to data collection; Kee Wook Jung, Ho June Song, and Gin Hyug Lee interpreted the data; Chung Sik Gong and Do Hoon Kim contributed to data interpretation and critical revision of the manuscript; Ga Hee Kim drafted the manuscript and prepared it for submission; All authors revised the manuscript critically for important intellectual content and approved the version to be published.


This work was supported by the Korean College of Helicobacter and an Upper Gastrointestinal Research Foundation grant.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

10620_2019_5774_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ga Hee Kim
    • 1
  • Ji Yong Ahn
    • 1
    Email author
  • Chung Sik Gong
    • 2
  • Mimi Kim
    • 3
  • Hee Kyong Na
    • 1
  • Jeong Hoon Lee
    • 1
  • Kee Wook Jung
    • 1
  • Do Hoon Kim
    • 1
  • Kee Don Choi
    • 1
  • Ho June Song
    • 1
  • Gin Hyug Lee
    • 1
  • Hwoon-Yong Jung
    • 1
  1. 1.Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research InstituteUniversity of Ulsan College of MedicineSeoulKorea
  2. 2.Department of Gastric Surgery, Asan Medical Center, Asan Digestive Disease Research InstituteUniversity of Ulsan College of MedicineSeoulKorea
  3. 3.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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