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Risk stratification for 1- to 2-cm gastric gastrointestinal stromal tumors: visual assessment of CT and EUS high-risk features versus CT radiomics analysis

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To investigate the ability of CT and endoscopic sonography (EUS) in predicting the malignant risk of 1–2-cm gastric gastrointestinal stromal tumors (gGISTs) and to clarify whether radiomics could be applied for risk stratification.

Methods

A total of 151 pathologically confirmed 1–2-cm gGISTs from seven institutions were identified by contrast-enhanced CT scans between January 2010 and March 2021. A detailed description of EUS morphological features was available for 73 gGISTs. The association between EUS or CT high-risk features and pathological malignant potential was evaluated. gGISTs were randomly divided into three groups to build the radiomics model, including 74 in the training cohort, 37 in validation cohort, and 40 in testing cohort. The ROIs covering the whole tumor volume were delineated on the CT images of the portal venous phase. The Pearson test and least absolute shrinkage and selection operator (LASSO) algorithm were used for feature selection, and the ROC curves were used to evaluate the model performance.

Results

The presence of EUS- and CT-based morphological high-risk features, including calcification, necrosis, intratumoral heterogeneity, irregular border, or surface ulceration, did not differ between very-low and intermediate risk 1–2-cm gGISTs (p > 0.05). The radiomics model consisting of five radiomics features showed favorable performance in discrimination of malignant 1–2-cm gGISTs, with the AUC of the training, validation, and testing cohort as 0.866, 0.812, and 0.766, respectively.

Conclusions

Instead of CT- and EUS-based morphological high-risk features, the CT radiomics model could potentially be applied for preoperative risk stratification of 1–2-cm gGISTs.

Key Points

• The presence of EUS- and CT-based morphological high-risk factors, including calcification, necrosis, intratumoral heterogeneity, irregular border, or surface ulceration, did not correlate with the pathological malignant potential of 1–2-cm gGISTs.

• The CT radiomics model could potentially be applied for preoperative risk stratification of 1–2-cm gGISTs.

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Abbreviations

DICOM:

Digital imaging and communications in medicine

EUS:

Endoscopic ultrasonography

gGISTs:

Gastric gastrointestinal stromal tumors

HPF:

High-power field

IQR:

Interquartile range

LASSO:

Least absolute shrinkage and selection operator

LI:

Labeling index

MI:

Mitotic index

NCCN:

The National Comprehensive Cancer Network

NIH:

National Institutes of Health

QDA:

Quadratic Discriminant Analysis

Rad-score:

Radiomics score

SD:

Standard deviation

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Peking University People’s Hospital, Beijing, 100044, China

    Xiaoxuan Jia, Shengcai Wei, Jin Cheng, Fan Chai, Caizhen Feng, Yulu Liu, Nan Hong & Yi Wang

  2. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Lijuan Wan & Hongmei Zhang

  3. Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Xiaoshan Chen & Shengxiang Rao

  4. Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China

    Wanying Ji, Yingshi Sun & Lei Tang

  5. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China

    Shaoqing Huang & Xinhua Zhang

  6. Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China

    Yuangang Qi

  7. United Imaging Intelligence (Beijing) Co., Ltd., Yongteng North Road, Haidian District, Beijing, 100094, China

    Jingjing Cui

  8. Department of Radiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, China

    Youping Xiao

  9. Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing, 100044, China

    Yingjiang Ye

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  1. Xiaoxuan Jia
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  20. Lei Tang
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  21. Yi Wang
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Corresponding authors

Correspondence to Shengxiang Rao, Xinhua Zhang, Youping Xiao, Yingjiang Ye, Lei Tang or Yi Wang.

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Guarantor

The scientific guarantor of this publication is Yi Wang.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

Jingjing Cui (United Imaging Intelligence (Beijing) Co., Ltd., Beijing, 100094, China Yongteng North Road, Haidian District, Beijing) kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• multicenter study

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Xiaoxuan Jia, Lijuan Wan, Xiaoshan Chen, Wanying Ji, Shaoqing Huang, and Yuangang Qi own equal first authorship of this manuscript.

Shengxiang Rao, Xinhua Zhang, Youping Xiao, Yingjiang Ye, Lei Tang, and Yi Wang own equal last authorship of this manuscript.

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Jia, X., Wan, L., Chen, X. et al. Risk stratification for 1- to 2-cm gastric gastrointestinal stromal tumors: visual assessment of CT and EUS high-risk features versus CT radiomics analysis. Eur Radiol 33, 2768–2778 (2023). https://doi.org/10.1007/s00330-022-09228-x

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