The roles of CT and EUS in the preoperative evaluation of gastric gastrointestinal stromal tumors larger than 2 cm
- 202 Downloads
This study aimed to investigate the endoscopic ultrasound (EUS) and computed tomography (CT) features of gastric gastrointestinal stromal tumors (GISTs) for assessing potential malignancy and prognosis.
Fifty consecutive patients with primary gastric GISTs larger than 2 cm were retrospectively enrolled in this study. The association of CT and EUS features with malignancy was analyzed using univariate and stepwise logistic regression method. The agreement between EUS/CT lesion size and pathologic tumor size was analyzed by calculating the intraclass correlation coefficient (ICC) value, and the association of imaging features with mitotic counts was further analyzed using univariate analysis. The Kaplan-Meier method and Cox proportional hazards models were used to assess the value of imaging features for predicting the prognosis of GIST patients.
Tumor size > 5 cm and an exophytic/mixed growth pattern on CT as well as tumor size > 5 cm and the presence of cystic spaces on EUS were independent predictors of highly malignant GISTs (all p < 0.05). The ICC values of CT/EUS lesion size relative to pathologic tumor size showed very good reliability (0.853 for EUS and 0.831 for CT). Only tumor shape and growth pattern on CT were significant for predicting mitotic index (both p < 0.05). Direct organ invasion on CT (p = 0.036; hazard ratio [HR] = 11.891) and serosal invasion on EUS (p = 0.015; HR = 8.223) were independent adverse prognostic factors.
CT features may be more useful than EUS features for predicting tumor mitotic index. In addition, preoperative imaging features can help predict the prognosis of gastric GISTs.
• Both CT and EUS features can be used for risk stratification of gastric GISTs larger than 2 cm.
• CT features performed better than EUS features for predicting tumor mitotic index.
• Preoperative imaging features can help predict the prognosis of gastric GISTs.
KeywordsGastrointestinal stromal tumors Prognosis Stomach neoplasms Endosonography Tomography, x-ray computed
Gastrointestinal stromal tumor
Intraclass correlation coefficient
National Institutes of Health
Tyrosine kinase inhibitor
We thank Xixi Zhao and Zelong Han for their contributions.
This study has received funding by the State’s Key Project of Research and Development Plan (2017YFC0108300 and 2017YFC0108303).
Compliance with ethical standards
The scientific guarantor of this publication is Tao Chen.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
- 3.Miettinen M, El-Rifai W, H L Sobin L, Lasota J (2002) Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 33:478–483Google Scholar
- 15.Belloni M, De Fiori E, Mazzarol G, Curti A, Crosta C (2002) Endoscopic ultrasound and computed tomography in gastric stromal tumours. Radiol Med 103:65–73Google Scholar
- 17.Nilsson B, Bümming P, Meis-Kindblom JM et al (2005) Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer 103:821–829Google Scholar
- 19.Bümming P, Ahlman H, Andersson J, Meis-Kindblom JM, Kindblom LG, Nilsson B (2006) Population-based study of the diagnosis and treatment of gastrointestinal stromal tumours. Br J Surg 93:836–843Google Scholar
- 27.Williams KB, Bradley JF, Wormer BA et al (2013) Pre-operative evalution of gastric gastrointestinal stromal tumors: endoscopic ultrasound vs CT scan. Annual Meeting of the SAGES: Society of American Gastrointestinal and Endoscopic Surgeons. Available via https://www.sages.org/meetings/annual-meeting/abstracts-archive/?search=Pre-operative+Evalution+of+Gastric+Gastrointestinal+Stromal+Tumors&meeting=2013. Accessed 13 Dec 2018