Digestive Diseases and Sciences

, Volume 54, Issue 6, pp 1265–1269 | Cite as

Predicting Malignant Potential of Gastrointestinal Stromal Tumors Using Endoscopic Ultrasound

  • Pari Shah
  • Feng Gao
  • Steven A. Edmundowicz
  • Riad R. Azar
  • Dayna S. EarlyEmail author
Original Article


Background The aim of this study was to determine which EUS characteristics correlate with malignant potential of GISTs. Methods All patients with a diagnosis of GIST based on surgical resection and preoperative EUS at our institution from January 2000 to July 2006 were identified. Pathology reports were used to determine NIH classification of each GIST and EUS exams were reviewed. EUS features were compared to NIH classification of very low/low risk malignant potential or intermediate/high risk malignant potential. Results Fourteen patients had lesions of very low or low risk malignant potential, and 12 patients had lesions of intermediate or high-risk malignant potential. EUS features of tumor size (P = 0.002), irregular extraluminal border (P = 0.005), local invasion (P = 0.02), and heterogeneity (P = 0.02) were statistically significant correlates of intermediate or high risk malignant potential. Conclusions EUS characteristics of tumor size, extraluminal border, depth, and heterogeneity can be used to predict malignant potential of GISTs.


Gastric neoplasms Benign Stomach Endoscopic ultrasound 


  1. 1.
    Davila RE, Faigel DO. GI stromal tumors. Gastrointest Endosc. 2003;58:80–88. doi: 10.1067/mge.2003.317.PubMedCrossRefGoogle Scholar
  2. 2.
    Miettinen M, El-Rifai W, Sobin L, Lasota J. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol. 2002;33(5):478–483. doi: 10.1053/hupa.2002.124123.PubMedCrossRefGoogle Scholar
  3. 3.
    Okai T, Minamoto T, Ohtsubo K, et al. Endosonographic evaluation of c-kit-positive gastrointestinal stromal tumors. Abdom Imaging. 2003;28:301–307. doi: 10.1007/s00261-002-0055-x.PubMedCrossRefGoogle Scholar
  4. 4.
    Fletcher DM, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459–465. doi: 10.1053/hupa.2002.123545.PubMedCrossRefGoogle Scholar
  5. 5.
    Shah R, Jonnalagadda S. The GIST of a stromal tumor. Gastroenterology. 2005;128(7):2170–2171. doi: 10.1053/j.gastro.2005.03.086.PubMedCrossRefGoogle Scholar
  6. 6.
    Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459–465. doi: 10.1053/hupa.2002.123545.PubMedCrossRefGoogle Scholar
  7. 7.
    Chak A, Canto MI, Rosch T, et al. Endosonographic differentiation of benign and malignant stromal cell tumors. Gastrointest Endosc. 1997;45:468–473. doi: 10.1016/S0016-5107(97)70175-5.PubMedCrossRefGoogle Scholar
  8. 8.
    Palazzo L, Landi B, Cellier C, et al. Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours. Gut. 2000;46:88–92. doi: 10.1136/gut.46.1.88.PubMedCrossRefGoogle Scholar
  9. 9.
    Nickl N, Gress F, McClave S, et al. Hypoechoic intramural tumor study: final report. Gastrointest Endosc. 2002;55:AB98.Google Scholar
  10. 10.
    Ji F, Wang ZW, Wang LJ, Ning JW, Xu GQ. Clinicopathological characteristics of gastrointestinal mesenchymal tumors and diagnostic value of endoscopic ultrasonography. J Gastroenterol Hepatol. 2008;23:e318–e324.Google Scholar
  11. 11.
    Sawaki A, Okubo K, Mizuno N, et al. Preoperative diagnosis of GISTS using endoscopic ultrasound guided fine needle aspiration biopsy. Gastrointest Endosc. 2004;59:237–238. doi: 10.1016/S0016-5107(04)01066-1.CrossRefGoogle Scholar
  12. 12.
    Taniguchi M, Nishida T, Hirota S, et al. Effect of c-kit mutation on prognosis of gastrointestinal stromal tumors. Cancer Res. 1999;59:4297–4300.PubMedGoogle Scholar
  13. 13.
    Lasota J, Wozniak A, Sarlomo-Rikala M, et al. Mutations in exons 9 and 13 of KIT gene are rare events in gastrointestinal stromal tumors. A study of 200 cases. Am J Pathol. 2000;157:1091–1095.PubMedGoogle Scholar
  14. 14.
    Sakurai S, Oguni S, Hironaka M, Fukayama M, Morinaga S, Saito K. Mutations in c-kit gene exons 9 and 13 in gastrointestinal stromal tumors among Japanese. Jpn J Cancer Res. 2001;92:494–498.PubMedGoogle Scholar
  15. 15.
    Rader AE, Avery A, Wait CL, McGreevey LS, Faigel D, Heinrich MC. Fine-needle aspiration biopsy diagnosis of gastrointestinal stromal tumors using morphology, immunocytochemistry, and mutational analysis of c-kit. Cancer Cytopathol. 2001;93:269–275.Google Scholar
  16. 16.
    Li SQ, O’Leary TJ, Sobin LH, Erozan YS, Rosenthal DL, Przygodzki RM. Analysis of KIT mutation and protein expression in fine needle aspirates of gastrointestinal stromal/smooth muscle tumors. Acta Cytol. 2000;44:981–986.PubMedGoogle Scholar
  17. 17.
    Ando N, Goto H, Niwa Y, et al. The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc. 2002;55:37–43. doi: 10.1067/mge.2002.120323.PubMedCrossRefGoogle Scholar
  18. 18.
    Yamada M, Niya Y, Hirooka Y, et al. FDG-PET imaging of gastrointestinal stromal cell tumors: correlation with histopathologic findings by using EUS-FNA. Scand J Gastroenterol. 2007;42:633–641. doi: 10.1080/00365520601040450.PubMedCrossRefGoogle Scholar
  19. 19.
    American Gastroenterological Association Institute. American Gastroenterological Association Institute medical position statement of the management of gastric subepithelial masses. Gastroenterology. 2006;130:2215–2216. doi: 10.1053/j.gastro.2006.04.032.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Pari Shah
    • 1
  • Feng Gao
    • 2
  • Steven A. Edmundowicz
    • 1
  • Riad R. Azar
    • 1
  • Dayna S. Early
    • 1
    Email author
  1. 1.Division of GastroenterologyWashington University School of Medicine in St. LouisSaint LouisUSA
  2. 2.Division of BiostatisticsWashington University School of Medicine in St. LouisSaint LouisUSA

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