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Building contrast-enhanced CT-based models for preoperatively predicting malignant potential and Ki67 expression of small intestine gastrointestinal stromal tumors (GISTs)

  • Special Section : Quantitative Imaging
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess contrast-enhanced computed tomography (CE-CT) features for predicting malignant potential and Ki67 in small intestinal gastrointestinal stromal tumors (GISTs) and the correlation between them.

Methods

We retrospectively analyzed the pathological and imaging data for 123 patients (55 male/68 female, mean age: 57.2 years) with a histopathological diagnosis of small intestine GISTs who received CE-CT followed by curative surgery from May 2009 to August 2019. According to postoperatively pathological and immunohistochemical results, patients were categorized by malignant potential and the Ki67 index, respectively. CT features were analyzed to be associated with malignant potential or the Ki67 index using univariate analysis, logistic regression and receiver operating curve analysis. Then, we explored the correlation between the Ki67 index and malignant potential by using the Spearman rank correlation.

Results

Based on univariate and multivariate analysis, a predictive model of malignant potential of small intestine GISTs, consisting of tumor size (p < 0.001) and presence of necrosis (p = 0.033), was developed with the area under the receiver operating curve (AUC) of 0.965 (95% CI, 0.915–0.990; p < 0.001), with 91.53% sensitivity, 96.87% specificity, 96.43% PPV, 92.54% NPV, 94.31% diagnostic accuracy. For high Ki67 expression, a model made up of tumor size (p = 0.051), presence of ulceration (p = 0.054) and metastasis (p = 0.001) may be the best predictive combination with an AUC of 0.785 (95% CI, 0.702–0.854; p < 0.001), 63.33% sensitivity, 76.34% specificity, 46.34% PPV, 86.59% NPV, 73.17% diagnostic accuracy. Ki67 index showed a moderate positive correlation with mitotic count (r = 0.578, p < 0.001), a weak positive correlation with tumor size (r = 0.339, p < 0.001) and with risk stratification (r = 0.364, p < 0.001).

Conclusion

Features on CE-CT could preoperatively predict malignant potential and high Ki67 expression of small intestine GISTs, and Ki67 index may be a promising prognostic factor in predicting the prognosis of small intestine GISTs, independent of the risk stratification system.

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Data availability

All datasets generated for this study are included in the manuscript.

Abbreviations

GIST:

Gastrointestinal stromal tumor

CE-CT:

Contrast-enhanced computed tomography

ROC:

Receiver operating characteristic

C.I.:

Confidence interval

AUC:

Area under the curve

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Acknowledgements

The authors thank Feng-Bo Huang for his technical assistance from the Department of Pathology, the Second Affiliated Hospital, School of Medicine, Zhejiang University and Dr. San-Hua Fang for his help in virtual microscopy system from Core Facilities, School of Medicine, Zhejiang University.

Funding

This work was supported by grants from the construction of major disease diagnosis and treatment technology research center—gastric cancer [Grant Numbers 17-2018-%s-0077] and the Zhejiang Medical and Health Science and Technology Plan Project [Grant Numbers 2021KY839].

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Author notes

  1. Miao-Ping Zhu and Qiao-Ling Ding contributed equally to the study and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China

    Miao-Ping Zhu, Qiao-Ling Ding, Chun-Yan Jiang, Chao Wang & Ri-Sheng Yu

  2. Department of Radiology, Hangzhou Women’s Hospital, Hangzhou, China

    Miao-Ping Zhu

  3. Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

    Jian-Xia Xu

  4. Department of Radiology, People’s Hospital of Songyang County, Lishui, China

    Chun-Yan Jiang

  5. Department of Radiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China

    Jing Wang

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  1. Miao-Ping Zhu
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Contributions

Zhu MP collected clinical and imaging data and participated in its design and coordination, Ding QL participated in the data processing and drafted the manuscript, Xu JX participated in its design and collected imaging data, Jiang CY collected clinical and imaging data and participated in the data processing; Wang J conceived of the study and participated in its design; Wang C collected clinical and imaging data and participated in its coordination; Yu RS conceived of the study, participated in its design and applied for the grants. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chao Wang or Ri-Sheng Yu.

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Conflict of interest

The authors declare they have no financial interests.

Ethical approval

The Institutional Review Board of Second Affiliated Hospital, School of Medicine, Zhejiang University approved this retrospective study and waived the requirement for written informed consent due to its retrospective nature.

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Zhu, MP., Ding, QL., Xu, JX. et al. Building contrast-enhanced CT-based models for preoperatively predicting malignant potential and Ki67 expression of small intestine gastrointestinal stromal tumors (GISTs). Abdom Radiol 47, 3161–3173 (2022). https://doi.org/10.1007/s00261-021-03040-9

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