Clinical implications of doubling time of gastrointestinal submucosal tumors

Abstract

AIMTo evaluate the efficacy of doubling time (DT) of gastrointestinal submucosal tumors (GIST).METHODSFrom April 1987 through November 2012, a total of 323 patients were given a final histopathological diagnosis of GISTs on surgical resection or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in Kitasato University East Hospital or Kitasato University Hospital. We studied 53 of these patients (34 with resected tumors and 19 with unresected tumors) whose tumors could be measured on EUS on at least two successive occasions. The histopathological diagnosis was GIST in 34 patients, leiomyoma in 5, schwannoma in 3, ectopic pancreas in 1, hamartoma in 1, cyst in 1, Brunner’s adenoma in 1, and spindle-cell tumor in 7. We retrospectively calculated the DT of GISTs on the basis of the time course of EUS findings to estimate the growth rate of such tumors.RESULTSThe DT was 17.2 mo for GIST, as compared with 231.2 mo for leiomyoma, 104.7 mo for schwannoma, 274.9 mo for ectopic pancreas, 61.2 mo for hamartoma, 49.0 mo for cyst, and 134.7 mo for Brunner’s adenoma. The GISTs were divided into risk classes on the basis of tumor diameters and mitotic figures (Fletcher’s classification). The classification was extremely low risk or low risk in 28 patients, intermediate risk in 3, and high risk in 3. DT of GIST according to risk was 24.0 mo for extremely low-risk plus low-risk GIST, 17.1 mo for intermediate-risk GIST, and 3.9 mo for high-risk GIST. DT of GIST was significantly shorter than that of leiomyoma plus schwannoma (P < 0.05), and DT of high-risk GIST was significantly shorter than that of extremely low-risk plus low-risk GIST (P < 0.05).CONCLUSIONFor GIST, a higher risk grade was associated with a significantly shorter DT. Small SMTs should initially be followed up within 6 mo after detection.

Gastric sub-epithelial tumors: identification of gastrointestinal stromal tumors using CT with a practical scoring method

“…Curative surgical resection is required for cure of gastric GISTs due to the high malignant potentials [2,3]. In contrast, almost all gastric non-GISTs SETs, mainly consist of leiomyoma and schwannoma [4,5], are benign and remain stable [4], so conservative medical management or less-invasive resection approach is usually recommended and performed [6,7]. Therefore, the accurate pre-operative differentiation of gastric GISTs from non-GISTs is of great importance for patients care and decision making [8].…”

EUS-guided sampling with 25G biopsy needle as a rescue strategy for diagnosis of small subepithelial lesions of the upper gastrointestinal tract

“…Follow-up of small GI-SELs is controversial. Koizumi et al have showed that doubling time differs according to the type of SELs, and GISTs were confirmed to have a significantly shorter doubling time (17.2 months) than the other types of tumors, thus suggesting that even small SELs should initially be followed up within at least 6 months after detection 30 .…”

Endoscopic ultrasonography diagnosis of subepithelial lesions

“…G ASTROINTESTINAL WALL IS detected as a fivelayer structure with lower frequency and a nine-layer structure with higher frequency (12)(13)(14)(15)(16)(17)(18)(19)(20) MHz) ( Fig. 1).…”

“…Size of GIST increased significantly during follow up; furthermore, the doubling time of high-grade GIST is 4.6 months, whereas that of moderate-low-grade GIST is 14 months. 14 In order to detect high-grade GIST, we recommend a follow-up schedule at 6 months, even if SEL which originated from the fourth layer are small. If the size and features are not significantly changed, then yearly follow up is recommended.…”

“…However, in order to prevent overlooking of high-grade GIST, we have to carry out the first follow up at 6 months. 14 Of course, we should carry HE Figure 16 Case of Brunnerioma. Endoscopy reveals a polypoid lesion with stalk in the duodenal bulb.…”