Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node.

OBJECTIVE: To study the feasibility and usefulness of ultrasound-guided pre-chemotherapy marking of pathologic lymph node followed by sentinel lymph node biopsy (SLNB)-pathologic node radioguided biopsy (ROLL) combined technique, in axillary involvement breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS: Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN ROLL biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection (ALND) was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate (FNR) and positive predictive value (PPV) of SLNB alone were also evaluated. RESULTS: Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44.4% for SLNB alone. We found a PPV of 37% for the SLNB. In 5 patients (18.5%) both SLNB and MBN were negative, avoiding ALND. CONCLUSIONS: SLNB-MBN radioguided biopsy ROLL combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of FNR of SLNB alone in this group of patients and avoiding a great number of ALND.

Ocular and systemic toxicity of high-dose intravitreal topotecan in rabbits: Implications for retinoblastoma treatment.

Although many more eyes of children with retinoblastoma are salvaged now compared to just 10 years ago, the control of vitreous seeding remains a challenge. The introduction of intravitreal injection of melphalan has enabled more eyes to be salvaged safely but with definite retinal toxicity. Intensive treatment with high-dose intravitreal topotecan may be a strategy to control tumor burden because of its cell cycle-dependent cytotoxicity and the proven safety in humans. Therefore, we evaluated the ocular and systemic safety of repeated high-dose intravitreal injections of topotecan in rabbits. Systemic and ocular toxicity was assessed in non-tumor-bearing rabbits after four weekly injections of three doses of topotecan (10 µg, 25 µg, and 50 µg) or vehicle alone. Animals were evaluated weekly for general and ophthalmic clinical status. One week after the last injection, vitreous and plasma samples were collected for drug quantification and the enucleated eyes were subjected to histological assessment. Weight, hair loss, or changes in hematologic values were absent during the study period across all animal groups. Eyes injected with all topotecan doses or vehicle showed no signs of anterior segment inflammation, clinical or histologic evidence of damage to the retina, and ERG parameters remained unaltered throughout the study. Vitreous and plasma topotecan lactone concentrations were undetectable. Four weekly intravitreal injections of topotecan up to 50 µg in the animal model or a 100 µg human equivalent dose were not toxic for the rabbit eye. High doses of topotecan may show promising translation to the clinic for the management of difficult-to-treat retinoblastoma vitreous seeds.

Characterization of Wet Olive Pomace Waste as Bio Based Resource for Leather Tanning.

Olive mill wastes represent an important environmental problem. Their high phenol, lipid, and organic acid concentrations turn them into phytotoxic materials. Specifically, wet olive pomace (WOP) is the waste generated in the two-phase continuous extraction process. WOP is a paste with around 60% water. The total volume of WOP generated is around 0.25 L/kg of olives processed. Its current waste management practices result in environmental problems as soil contamination, underground seepage, water-bodies pollution, and foul odor emissions. Some valorization alternatives include composting, biological treatments, direct combustion for energy production, or direct land application. The leather industry is making great efforts to apply cleaner processes while substituting chemical products for natural products. In this way, different alternatives are being studied, such as the use of zeolites, triazine derivatives, grape seed extract, olive leaf extract, etc. In this work, the use of wet olive pomace is presented as a possible alternative to conventional vegetable tannins (mimosa, quebracho, chestnut, etc.). Although different projects and studies have been developed for the valorization of olive mill wastes, there is completely a new approach to the WOP application for tanning purposes. This study shows that WOP has a significant number of polyphenolic substances, so it has a great potential to be used as a tanning agent. Specifically, this study has been able to determine that, of the polyphenols present in WOP, 39.6% correspond to tannins that are capable of tanning the skin. Additionally, it contains 14.3% non-tannins, that is, molecules that by themselves do not have the capacity to tan the leather but promote the tanning mechanism and improve the properties of the tanned leather.

CT differentiation of fat-poor angiomyolipomas from papillary renal cell carcinomas: development of a predictive model.

PURPOSE: To identify specific contrast-enhanced CT (CECT) findings and develop a predictive model with logistic regression to differentiate fat-poor angiomyolipomas (fpAML) from papillary renal cell carcinomas (pRCC). METHODS: This is a single-institution retrospective study that assess CT features of histologically proven 67 pRCC and 13 fpAML. CECT variables were studied by means of univariate logistic regression. Variables included patients' demographics, tumor attenuation (unenhanced and at arterial, venous and excretory post-contrast phases), type of enhancement, morphological features (axial long and short diameters, long-short axis ratio (LSR) and tumor to kidney angle interface) and presence of visible calcifications or vessels. Those variables with a p ≤ 0.05 underwent standard stepwise logistic regression to find predictive combinations of clinical variables. Best models were evaluated by AUROC curves and were subjected to Leave-one-out cross validation to assess their robustness. RESULTS: Odds ratio (OR) between pRCC and fpAML was statistically significant for patient's gender, tumor attenuation in arterial, venous and excretory phases, tumor's long diameter, short diameter, LSR, type of enhancement, presence of intratumoral vessels and tumor-kidney angle interface. The best predictive model resulted in an area under the curve (AUC) of 0.971 and included gender, tumor-kidney angle interface and venous attenuation with the following equation: Log(p/1 - p) = - 2.834 + 4.052 * gender + - 0.066 * AngleInterface + 0.074 * VenousphaseHU. CONCLUSIONS: The combination of patients' gender, tumor to kidney angle interface and venous enhancement helps to distinguish fpAML from pRCC.

Ex vivo confocal microscopy performs real-time assessment of renal biopsy in non-neoplastic diseases.

BACKGROUND: Ex vivo confocal microscopy is a technique for tissue examination, which generates images of fresh samples with an optical resolution comparable to those obtained by conventional pathology. The objective of this study was to evaluate the feasibility of using ex vivo confocal microscopy in fusion mode (reflectance and fluorescence) and the H&E-like digital staining that is obtained for the analysis of non-neoplastic kidney biopsies. METHODS: Twenty-four renal samples acquired from autopsies were scanned in a 4th generation ex vivo confocal microscopy device. The imaging process was completed in an average of three minutes. RESULTS: Confocal images correlated very well to the corresponding conventional histological sections, both in normal tissue and in chronic lesions (glomerulosclerosis, fibrosis and tubular atrophy). The ex vivo confocal microscopy protocol did not add artifacts to the sample for the ulterior study with light microscopy, nor to the histochemical or immunohistochemical studies. CONCLUSION: The ease and speed of grayscale and fluorescence image acquisition, together with the quality of the H&E-like digitally stained images obtained with this approach, suggest that this technique shows promise for use in clinical nephrology and renal transplantation.

Genetic and environmental risk factors for vitiligo and melanoma in Pura Raza Español horses.

BACKGROUND: Vitiligo and melanoma are relatively common disorders in grey Pura Raza Español horses and other horse breeds with grey-coloured coats. OBJECTIVES: To determine the breed prevalence, environmental risks factors and estimate the genetic parameters for vitiligo and melanoma in Pura Raza Español horses. STUDY DESIGN: Retrospective cohort study. METHODS: We analysed data from a large worldwide population of Pura Raza Español horses. The database included the vitiligo and melanoma scores, on either a four- or six-point linear scale, of 11,436 horses. Genetic parameters were estimated using a Bayesian genetic animal model including the four associated environmental risk factors as systematic effects. Inbreeding was used as a covariate, and animal and residual effects were included as random effects. RESULTS: Of the horses included in the study, 2.8 and 20.5% showed some traces of vitiligo around the eyes and mouth, respectively, while 1.6% showed varying degrees of melanoma. Age, coat colour and inbreeding were significantly associated with the three outcomes studied. The estimated heritability for the whole population was 0.09 (s.d. +0.019), 0.44 (s.d. +0.031) and 0.13 (s.d. +0.037), for eye vitiligo score, nostril vitiligo score and melanoma scores respectively. The genetic correlations ranged from 0.42 (s.d. +0.084) between eye and nostril vitiligo score to 0.15 (s.d. +0.096) between nostril vitiligo and melanoma. MAIN LIMITATIONS: Vitiligo scores for the perianal regions were not collected. The veterinarian responsible for each assessment was not recorded. CONCLUSIONS: Vitiligo and melanoma are prevalent in this population and those environmental risk factors and genetics both have an effect on the clinical expression of the diseases. These findings may help to reduce prevalence through breeding programmes.

Systematic review of kidney transplantation functional predictors. / Revisión sistemática de los métodos predictores de la funcionalidad del trasplante renal.

CONTEXT: Kidney transplantation from donors with expanded criteria has increased the pool of kidneys at the cost of a higher risk of short and long-term graft dysfunction. The main issue lies in determining which kidneys will offer acceptable function and survival compared with the risk represented by surgery and subsequent immunosuppression. OBJECTIVE: The objective of our article is to review the current evidence on the tools for predicting the functionality of kidney transplantation from cadaveric donors with expanded criteria and determining the validity for their use in standard practice. ACQUISITION OF EVIDENCE: We conducted a systematic literature review according to the PRISM criteria, through Medline (http://www.ncbi.nlm.nih.gov) and using the keywords (in isolation or in conjunction) "cadaveric renal transplantation; kidney graft function appraisal, graft function predictors". We selected prospective and retrospective series and review articles. A total of 375 articles were analysed, 39 of which were ultimately selected for review. SUMMARY OF THE EVIDENCE: The predictors of functionality include the following: The donor risk indices; the calculation of the renal functional weight or the assessment of the nephronic mass; the measurement of vascular resistances during perfusion in hypothermia; the measurement of the donor's biomarkers in urine and in the perfusion liquid; the measurement of functional and reperfusion parameters in normothermia; and the measurement of morphological parameters (microscopic and macroscopic) of the target organ. In this article, we present an explanatory summary of each of these parameters, as well as their most recent evidence on this issue. DISCUSSION: None of the reviewed parameters in isolation could reliably predict renal function and graft survival. There is a significant void in terms of the macroscopic assessment of kidney transplantation. CONCLUSIONS: We need to continue developing predictors of renal functionality to accurately define the distribution of each currently available donor kidney.

Association of Brain-Dead Donors' Terminal Inflammation With Delayed Graft Function in Kidney Transplant Recipients.

BACKGROUND: Systemic inflammation affects kidney function in a wide range of diseases. Even in kidney transplant recipients, higher levels of C-reactive protein (CRP) are invariably associated with both worse short- and long-term graft outcomes. However, little is known about systemic inflammation in kidney donors and, notably, brain death causes a strong systemic inflammatory response. OBJECTIVE: To analyze the role of systemic inflammation of brain-dead donors on short-term kidney graft outcomes (ie, delayed graft function [DGF], defined as the need of dialysis during the first week after transplantation). MATERIALS AND METHODS: Retrospective analysis of clinical and biochemical characteristics of all brain-dead kidney donors generated in the Hospital Clínic of Barcelona in the 2006 to 2015 period (n = 194). Donors who were tested for CRP in the 24 hours before BD declaration were included (n = 97, 50% of initial population). Clinical and biochemical features of their respective recipients (n = 165) were analyzed, comparing recipients who developed DGF (n = 30) with recipients who did not (n = 135). RESULTS: Donors whose recipients later developed DGF had much higher CRP values (10.58 [5.1-18.21] vs 4.81 [1.42-12.2] mg/dL, P = .025). Other characteristics associated with the development of DGF were renal biopsy score and recipient dialysis vintage (P = .025 and P = .002, respectively). In logistic regression analysis, PCR maintained significance in the non-expanded criteria donor (ECD) group (odds ratio [OR], 1.102; P = .027), but it lost significance in the ECD group (P = .67). CONCLUSIONS: Terminal donor CRP was associated with DGF in kidney transplant recipients and proved to be mostly significant in younger donors.

Association analysis of KIT, MITF, and PAX3 variants with white markings in Spanish horses.

Several variants in the KIT, PAX3 and MITF genes have previously been associated with white markings in horses. In this study, we examined eight variants of these genes in 70 Menorca Purebred horses (PRMe, only black solid-coloured horses) and 70 Spanish Purebred horses (PRE, different coat colour patterns) that were scored for the extent of white markings. A maximum-likelihood chi-square test, logistic regression model and ridge regression analyses showed that a missense mutation (p.Arg682His) in KIT was associated with white facial markings (P < 0.05) and with total white markings (P < 0.05) in PRMe horses. The relative contribution of this variant to white markings in PRMe horses was estimated at 47.6% (head) and 43.4% (total score). In PRE horses, this variant was also associated with hindlimb scores (P < 0.05) with a relative contribution of 41.2%. The g.20147039C>T intronic variant located 29.9 kb downstream from the transcription start site of the MITF gene was associated with less white markings on forelimbs (P < 0.05) in PRMe horses, with a relative contribution of 63.9%, whereas in PRE horses this variant was associated with white facial markings (P < 0.05), with a relative contribution of 63.9%. No significant associations were found for PAX3 variants in these breeds. These results show that KIT and MITF variants are involved in the white marking patterns of both PRMe and PRE horses, providing breeders with an opportunity to use genetic testing to aid in breeding for their desired level of white markings.

Vitellogenin, sex steroid levels and gonadal biomarkers in wild Solea solea and Solea senegalensis from NW Mediterranean fishing grounds.

Specimens of Solea solea and Solea senegalenesis at different developmental stages were obtained from seven fishing grounds along the NW Mediterranean. Gonad development in males was classified into five stages, from early spermatogenesis to recovery, while four stages were considered in females, from growth to maturation. Vitellogenin (VTG) and sex steroid levels including an estrogen (estradiol, E2), two androgens (testosterone, T and 11-ketotestosterone, 11KT) and a progestin (17,20ß-dihydroxy pregn-4-en-3-one, 17,20ß-P or maturation inducing steroid, MIS) were analysed in plasma. Their levels were more clearly related to the developmental stage of the gonads than to the sampling site characteristics. In addition, enzyme activities in gonads, such as acetylcholinesterase (AChE) and carboxylesterase (CbE) were gender-dependent and higher in males than in females. Gonadal glutathione S-transferase (GST) activity was enhanced in the most anthropogenic impacted sites. VTG was absent in males and very low or undetectable in immature females, while mature females exhibited high VTG levels, clearly related to the gonado-somatic index. Sex steroid levels (ng/ml) varied in males and females regardless of the species. E2 levels in females ranged from 0.22 to 6.98 while in males ranged from 0.11 to 0.27. T varied from 0.12 to 0.93 in females and from 0.56 to 1.36 in males, while 11KT in females fluctuated from 0.03 to 0.57 and from 0.26 to 6.42 in males. Similarly, MIS in females ranged from 0.75 to 3.71 and from 1.12 to 5.61 in males. The lack of endocrine disturbances was confirmed by histological examination of the gonads. This study informs on basal sex hormone levels and enzyme activities during gonadal maturation of wild Solea spp. that can be useful in the identification and further remediation of possible pollution events.

Spanish consensus document for acceptance and rejection of kidneys from expanded criteria donors.

In the recent years, more than 60% of available deceased donors are either older than 50 yr or have significant vascular comorbidities. This makes the acceptance and rejection criteria of renal allografts very rigorous, especially in cases of younger recipients, and at the same time encourages live donations. In our country, there is a lack of homogeneity in the percentages of use of expanded criteria donor (ECD) allografts between the different autonomous communities. Furthermore, the criteria vary greatly, and in some cases, great importance is given to the biopsy while in others very little. In this study, we present a unified and homogenous criteria agreed upon by consensus of a 10-member Panel representing major scientific societies related to renal transplantation in Spain. The criteria are to be used in accepting and/or rejecting kidneys from the so-called ECDs. The goal was to standardize the use of these organs, to optimize the results, and most importantly to provide for the maximum well being of our patients. Finally, we believe that after taking into account the Panel's thorough review of specific scientific literature, this document will be adaptable to other national renal transplant programmes.

[Hypersensitivity reaction to etoposide. A case report]. / Reacción de hipersensibilidad a etopósido. A propósito de un caso.

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Comparison of acquisition of resistant microorganisms and infections in critically-ill patients with and without malignancies.

BACKGROUND: Patients with malignancies are often considered at risk of acquiring infections by resistant or potentially resistant microorganisms (RPRMs). However, data supporting this contention is scarce. We have compared critically ill patients with haematological malignancies (HM), solid tumours (ST) and without cancer (NC) in terms of acquisition of RPRMs, infections and mortality. METHODS: Observational, prospective cohort study of patients admitted to a medical intensive care unit (ICU). Swabbing of nares, pharynx and rectum, and culture of respiratory secretions were obtained within 48 h of admission and thrice weekly thereafter. Clinical samples were obtained as deemed necessary by the attending physician. Clinical variables, severity scores on admission and exposures during ICU stay were also collected. Multivariable logistic regression analysis was used to evaluate ICU mortality. RESULTS: Out of 969 included patients 127 (13.1%) had HM and 93 (9.6%) had ST. Patients with malignancies were more frequently exposed to central venous catheterization, methylprednisolone, and any antipseudomonal antibiotic whereas they were less commonly exposed to invasive mechanical ventilation. Patients with HM were more often admitted with an infection. There were no differences among groups in terms of RPRMs acquisition during ICU stay or prevalence of ICU-acquired infections due to any microorganism, including RPRMs. Having a HM was an independent predictor of mortality regardless of APACHE II score. CONCLUSION: Critically ill cancer patients did not show a higher rate of RPRMs acquisition nor ICU-acquired infections. Mortality was higher in the HM group and it was not accurately predicted on admission by APACHE II score.

Mixed cryoglobulinaemia not related to hepatitis C virus, mesangiocapillary glomerulonephritis and lymphoplasmocytic lymphoma.

Kidney involvement associated to lymphoma is a known phenomenon but frequently not characterized due to the low frequency with which biopsies are realized in these patients. Several histological patterns can co-exist and happen unnoticed without a biopsy. Parenchyma infiltration in kidney for lymphoma has been found in 34% (post-mortem) and 14% (pre-mortem) and have low incident of clinical manifestations. Other patterns of renal injury are associated to lymphoma and minimal changes disease is especially related with Hodgkin's lymphoma. Renal lesions associated to paraprotein in lymphoplasmacytic lymphoma are an exceptional association, in spite of in 20% of them, appear cryoglobulinemia. There are a few cases reported in the literature with different histological patterns: light-chain disease, amyloidosis, and immunotactoid glomerulopathy related with kidney injury in patients with lymphoma. A 39-year-old male presented an association among paraproteinemia, membrano-proliferative glomerulonephritis no hepatitis C virus related and lymphoplasmacytic lymphoma with renal infiltration. This case emphasized the variety of renal lesions that lymphomas could trigger and the value of the nephropathology in the diagnosis and outcome of the hematologic diseases with paraproteinemia.

Nephropathy associated with antiphospholipid antibodies in patients with systemic lupus erythematosus.

BACKGROUND: Nephropathy associated with antiphospholipid antibodies (aPL) has been proposed as a risk factor of worse renal prognosis in patients with systemic lupus erythematosus (SLE). The purpose of the current study was to evaluate the prevalence of aPL-associated nephropathy (aPLN) among patients with lupus nephritis and to describe their functional renal outcome. METHODS: A total of 79 renal biopsies from 77 patients followed at the Hospital Clinic, Spain were analysed. Each renal biopsy was evaluated by a pathologist who was blinded to the aPL status. Thrombotic microangiopathy (TMA), fibrous intimal hyperplasia (FIH), fibrocellular arterial occlusion (FAO), focal cortical atrophy (FCA), and tubular thyroidization as lesions suggestive of aPLN were identified. RESULTS: aPLN was found in nine (11.4%) biopsies. TMA was found in three (33.3%) cases whereas chronic aPLN, represented by FIH and FCA, was found in four (44.4%) and three (33.3%) cases, respectively. A significant association between the presence of aPL and aPLN was found (p = 0.003). Patients with lupus anticoagulant (LA) plus IgG anticardiolipin antibodies (aCL) showed an increased prevalence of aPLN (OR: 3.61, 95% CI 1.28-5.14; p = 0.002). Creatinine levels were significantly increased in patients with aPLN compared with those with aPL without aPLN (p = 0.038). However, no significant difference in complete remission, partial remission, not response, and established renal damage between groups was observed at the end of follow-up. CONCLUSIONS: The aPL have an important role in the pathogenesis of renal lesions in SLE patients. Prospective studies are needed to address the role of aPLN in the long-term outcome of SLE patients with positive aPL.

Validating a multi-biomarker approach with the shanny Lipophrys pholis to monitor oil spills in European marine ecosystems.

Oil spills are an importance source of polycyclic aromatic hydrocarbons (PAHs) in the aquatic environment. Intertidal communities are particularly sensitive since most organisms from these ecosystems are sessile or present reduced mobility. Hence, it is important to validate the use of resident species as sentinels to characterize the impact of oil spills on the rocky shores and the improvement during the restoration process. Recently the advantages of using the shanny Lipophrys pholis in pollution monitoring within the northwestern Atlantic coast has been pointed out. Therefore, with the aim of further validating the use of L. pholis in pollution monitoring associated with petrogenic hydrocarbon contamination, a multi-biomarker approach study was carried out 1 week after a moderate oil spill from the waste treatment plant (WTP) of the major Portuguese refinery in the north of Portugal (Petrogal). Fish collected at 2 km from the accident displayed a significant induction of ethoxyresorufin-O-deethylase activity (EROD) and fluorescent aromatic compounds (FACs) in bile (up to a 5-fold induction) in comparison with the pre-spill scenario, and a 15% induction in erythrocytic nuclear abnormalities (ENA), a biomarker of genotoxicity. In contrast, no significant differences were recorded in the reference site. In order to better characterize the time-course accumulation of FACs in bile after a PAH insult, laboratory exposure of L. pholis to benzo[a]pyrene (B[a]P) was performed. A clear dose-response accumulation of B[a]P metabolites was observed that closely reflected nominal exposure concentrations already after 3d. Overall, the findings of the present study highlight the potential of L. pholis in pollution monitoring dealing not only with chronic contamination, but also with oil spill accidents of a moderate scale. Taking into consideration that EROD and FACs determinations in L. pholis are cost effective, rapid and easy to use, they offer a great potential to be incorporated into risk assessment of PAHs in the scope of national monitoring programs and the European Water Policy legislation.

Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study.

BACKGROUND AND AIM: The diagnosis of gastrointestinal stromal tumors (GISTs) has important prognostic and therapeutic implications. The specific diagnosis of GIST has to be based on immunocytochemistry. This study aimed to prospectively compare in a crossover manner the accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB) in the specific diagnosis of gastric GISTs. We hypothesized that EUS-TCB is superior to EUS-FNA in this respect. PATIENTS AND METHODS: Forty patients with gastric subepithelial tumors suspected on the basis of EUS of being a GIST underwent both EUS-FNA and EUS-TCB. The sequence in which the techniques were employed was randomly assigned to avoid bias. RESULTS: Forty tumors were sampled (mean number of passes: 2.1 +/- 0.9 with EUS-TNB and 1.9 +/- 0.8 with EUS-FNA; P = not significant, NS). Final diagnoses were: GIST (n = 27), carcinoma (n = 2), leiomyoma (n = 1), schwannoma (n = 1), and no diagnosis possible (n = 9). Device failure occurred in 6 patients with EUS-TCB. A cytohistological diagnosis of mesenchymal tumor (n = 29) and carcinoma (n = 2) was made in 70 % of cases by EUS-FNA and in 60 % of cases by EUS-TCB ( P = NS). Among the samples that were adequate, immunohistochemistry could be performed in 74 % of EUS-FNA samples and in 91 % of EUS-TCB samples ( P = 0.025). When inadequate samples were included, the overall diagnostic accuracy of EUS-FNA was 52 % and that of EUS-TCB was 55 % ( P = NS). There were no complications. CONCLUSIONS: EUS-TCB is not superior to EUS-FNA in GISTs because of the high rate of technical failure of trucut. However, when an adequate sample is obtained with EUS-TCB, immunohistochemical phenotyping is almost always possible. EUS-TCB can be safely performed in this set of patients.