Correlation of Endoscopic Ultrasonography Features with the Mitotic Index in 2- to 5-cm Gastric Gastrointestinal Stromal Tumors

Abstract

Background: Predicting the malignancy potential of gastrointestinal stromal tumor (GIST) before resection could improve patient management strategies, as gastric GISTs with a low malignancy potential can be safely treated endoscopically, but surgical resection is required for those tumors with a high malignancy potential. This study aimed to evaluate endoscopic ultrasound (EUS) features of 2–5 cm gastric GISTs that might be used to predict their mitotic index using surgical specimens as the gold standard. Patients and Methods: Forty-nine patients (30 females and 19 males; mean age 55.1 ± 12.7 years) who underwent EUS examinations, followed by surgical resections of 2–5 cm gastric GISTs were retrospectively reviewed. Results: The mean tumor size was 3.44 ± 0.97 cm (range 2.1–5.0 cm). A univariate analysis revealed no significant differences in age, sex, and tumor location in the low mitotic index and high mitotic index groups (all P > 0.05). In terms of EUS features, there were no significant differences in the mitotic indexes with respect to the shape, surface lobulation, border regularity, echogenicity, homogeneity, growth patterns, presence of mucosal ulceration, hyperechogenic foci, anechoic spaces, and hypoechoic halos (all P > 0.05). However, the tumor size was larger in the high mitotic index group than in the low mitotic index group (3.97 ± 1.05 vs. 3.27 ± 0.9 cm, P = 0.03). Conclusion: Conventional EUS features are not reliable for predicting the mitotic index of 2–5 cm gastric GISTs. Further modalities for predicting the mitotic index are needed to prevent unnecessary surgical resections in patients with a low risk of malignancy.

Computed tomography in the size measurement of gastric gastrointestinal stromal tumors: Implication to risk stratification and “wait-and-see” tactics

“…Regrettably, evidence is still rare in the precise calculation of the mitotic index of GISTs before resection. Seven et al [28] consisted that tumor size itself could predict mitotic index, whereas small GISTs could a high mitotic index showing potential malignancy [29]. In our present study, it is calculated that 8.54% small GISTs and 26.12% GISTs of 2e5 cm with the mitotic index over 5/50HPFs.…”

Imaging Gigantic Small Bowel Gastrointestinal Stromal Tumours Through Different Radiological Lenses: A Case Report

“…A B determine the layer from which the submucosal lesions originate, apart from its endoscopic findings. [12][13][14][15] However, exophytic lesions are not easily detected on endoscopy; in such cases, transabdominal ultrasound is the first modality to diagnose the GIST. Plus, core particles obtained from transabdominal ultrasound-guided biopsy are superior to endoscopic ultrasoundguided biopsy to assess the mitotic index, and determine risk for malignant potential.…”

Gastritis Cystica Profunda: A Rare Disease, a Challenging Diagnosis, and an Uncertain Malignant Potential: A Case Report and Review of the Literature

“…In the present case, EUS and FNB were performed, showing a submucosal antral mass with a heterogeneous echo penetrating the muscolaris propriae. When contrast was administered, the lesion presented hyperechoic septa and anechoic holes, features indicative of GIST [26]. We did not include GCP among the possible differential diagnoses of the lesion, because of its very low incidence and unspecific presentation.…”