New Device for Diagnosis of Gastric Submucosal Tumor: Endoscopic Direct Biopsy Using Thorny Needle

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Abstract
The histopathological examination of the submucosal tumor without surgical intervention has been difficult. The ordinary gastroscopic forceps were thought to be ineffective to obtain the material from the lesion. To cope with these difficulties, the thorny needle biopsy method was invented using adental cleanser needle. Through the built-in channel of the biopsy gastrofiberscope, the needle was inserted into the lesion. The material attached to the needle was removed and either direct smearing or the preparation after membrane filtration was carried out. The Papanicolaou staining was used for cytological examination. The method was applied to 113 cases of submucosal tumor of the stomach. In 19 cases, surgically removed specimen or specimen removed by high frequency current endoscopic polypectomy were available for comparison. In 9 of 12 myogenic tumors (75%) tumor cells were obtained by this method. Three of these 9 cases were leiomyosarcoma and 2 of them were so diagnosed before surgery. In 1 case the re-examination after surgery of the previously obtained biopsy material by the thorny needle method revealed presence of the tumor cells. In 1 case of the aberrant pancreas, the correct pre-surgical diagnosis was made. The method can be applied without significant hazards to the patients with submucosal tumors especially myogenic tumors or aberrant pancreas even in out-patient clinics and can be used as the new method for the screening of malignant tumor and highly atypical tumor of submucosal nature.

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