Background. Although it is possible to visualize gastrointestinal stromal tumors (GIST) of the stomach by endoscopy, their pretreatment histological diagnosis is often difficult. The aim of this study was to investigate predictors of accurate preoperative pathological diagnosis of gastric GIST. Material and Methods. We retrospectively studied patients with gastric GIST who had undergone pretreatment endoscopic biopsy and surgery, and examined their clinicopathological data. Results. Twenty-three patients were eligible. Thirty-four endoscopic biopsies (mean 2.6, range 1–8) were obtained. Preoperative pathological diagnoses of GIST were made in 18 patients. Precise diagnoses were made in 18 (52.9%) of the 34 biopsies. Endoscopic ultrasound (EUS) resulted in precise diagnoses in 11 (91.7%) of the 12 biopsy specimens. Fine-needle aspiration (FNA) biopsy resulted in precise diagnoses in 11 (84.6%) of the 13 biopsy specimens. The accuracy of pathological diagnosis by EUS-guided FNA biopsy was 100%. The procedure of EUS-guided FNA biopsy had no complications or recurrent disease. In a multivariate analysis, only EUS achieved a significantly superior rate of diagnosis (odds ratio, 11.884; 95% confidence interval, 1.204–289.230; ). Conclusion. EUS-guided FNA biopsy is the most accurate for pretreatment pathological diagnosis of gastric GIST and for prevention of both of early complications and disease recurrence. 1. Background Gastric submucosal tumors (SMTs), a rare disease, are often found incidentally during gastric surgery [1]. The commonest gastric SMT is gastrointestinal stromal tumor (GIST) [2]. GISTs are the commonest mesenchymal subepithelial tumors of the gastrointestinal tract. Although most small GISTs are benign tumors, risk classification for GIST by mitotic index, size and tumor site was provided [3]. Although biopsies generally provide a histological diagnosis and thus facilitate planning of the treatment strategy, it is sometimes difficult to make a pathological diagnosis of gastric SMTs because they are covered by normal gastric mucosa. In addition, biopsies of gastric GISTs may cause tumor rupture and dissemination [3]. Thus, gastric GISTs are often evaluated by computed tomography (CT) [4], magnetic resonance imaging (MRI) [5], and positron emission tomography (PET) [6]. Some new biopsy techniques [7, 8] for safe and effective diagnosis of gastric SMT have recently been developed. The usefulness of fine-needle aspiration (FNA) biopsy has also been reported [9–11]. The most powerful advantage of FNA biopsies is that physicians can extract
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