الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 33 |  |  |
| | | from | 33 | | |
Abstract
EUS should be done for any submucosal mass to know if this mass is intramural or resulting from extramural compression from outside. In intramural masses, EUS can define the consistency, the size, the layer of origin, the echogenicity, the vascularity and the presence or absence of adjacent lymph nodes.
EUS guided fine needle aspiration (FNA) and histopathological examination should be done for some submucosal masses to put a definite diagnosis. In cases of lipoma, FNA is generally not needed due to the high accuracy of EUS in diagnosing lipomas without biopsy.
FNA and histopathology are necessary for determination if the submucosal mass is benign or malignant and to define the different types of the benign masses. EUS criteria alone without FNA and histopathologic examination can be used in some cases to differentiate between Benign and malignant lesions to reduce the cost. (All homogenous lesions are benign, the size of 4.5 cm is a cut off > 4.5 cm are malignant lesions and < 4.5 cm are benign lesions, submucosal lesions with enlarged benign lymph nodes by EUS criteria alone are benign lesions, submucosal lesions with enlarged malignant lymph nodes by EUS criteria are malignant lesions, all submucosal lesions without areas of breakdown are benign lesions and any submucosal lesions infiltrating all layers are malignant lesions).
EUS with colored Doppler is necessary in differentiating cystic from vascular lesions.
Recommendations
We recommend a similar study with much larger number of patients to be able to put accurate criteria in differentiating benign from malignant submucosal lesions to reduce the need for FNA and histopathology.