Digital image analysis-based scoring system for endoscopic ultrasonography is useful in predicting gastrointestinal stromal tumors
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When gastric mesenchymal tumors (GMTs) measuring 2–5 cm in size are found, whether to undergo further treatment or not is controversial. Endoscopic ultrasonography (EUS) is useful for the evaluation of malignant potential of GMTs, but has limitations, such as subjective interpretation of EUS images. Therefore, we aimed to develop a scoring system based on the digital image analysis of EUS images to predict gastrointestinal stromal tumors (GISTs).
We included 103 patients with histopathologically proven GIST, leiomyoma or schwannoma on surgically resected specimen who underwent EUS examination between January 2007 and June 2018. After standardization of the EUS images, brightness values, including the mean (Tmean), indicative of echogenicity, and the standard deviation (TSD), indicative of heterogeneity, in the tumors were analyzed.
Age, Tmean, and TSD were significantly higher in GISTs than in non-GISTs. The sensitivity and specificity were almost optimized for differentiating GISTs from non-GISTs when the critical values of age, Tmean, and TSD were 57.5 years, 67.0, and 25.6, respectively. A GIST-predicting scoring system was created by assigning 3 points for Tmean ≥ 67, 2 points for age ≥ 58 years, and 1 point for TSD ≥ 26. When GMTs with 3 points or more were diagnosed as GISTs, the sensitivity, specificity, and accuracy of the scoring system were 86.5%, 75.9%, and 83.5%, respectively.
The scoring system based on the information of digital image analysis is useful in predicting GISTs in case of GMTs that are 2–5 cm in size.
KeywordsStomach Endoscopic ultrasonography Gastrointestinal stromal tumor Mesenchymal tumor Image analysis
This study was supported by Biomedical Research Institute Grant (2018B015), Pusan National University Hospital and a Busan Cancer Center Research Grant (2018), Pusan National University Hospital.
GHK and KBK jointly conceived the study. MWL, GHK and YHK performed the data analysis. MWL, GHK, DYP, CIC, DHK, and TYJ were responsible for the data collection and contributed to the data analysis and writing of the manuscript. MWL and GHK contributed to the interpretation of the results, and reviewed the manuscript. All authors critically revised each stage of the manuscript and all authors approved the final draft for submission.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1964 and later versions.
Informed consent or a substitute for it was obtained from all patients before they were included in the study.