Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors

Abstract

BACKGROUND Gastrointestinal stromal tumors (GISTs) with a diameter of < 2 cm are called small GISTs. Currently, endoscopic ultrasound (EUS) is widely used as a regular follow-up method for GISTs, which can also provide a preliminary basis for judging the malignancy potential of lesions. However, there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs. AIM To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs. METHODS We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019. The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery. Preoperative EUS features (marginal irregularity, cystic changes, homogeneity, ulceration, and strong echogenic foci) were retrospectively analyzed. The assessment results based on EUS features were compared with the pathological features. RESULTS A total of 256 patients (69 men and 187 women) were enrolled. Pathological results included 232, 16, 7, and 1 very low-, low-, intermediate-, and high-risk cases, respectively. The most frequent tumor location was the gastric fundus (78.1%), and mitoses were calculated as > 5/50 high power field in 8 (3.1%) patients. Marginal irregularity, ulceration, strong echo foci, and heterogeneity were detected in 1 (0.4%), 2 (0.8%), 22 (8.6%), and 67 (65.1%) patients, respectively. However, cystic changes were not detected. Tumor size was positively correlated with the mitotic index ( P < 0.001). Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential (95% confidence interval: 0.824–0.956). EUS heterogeneity with tumor diameters > 1.48 cm was associated with higher risk classification ( P < 0.05). CONCLUSION Small GISTs (diameters > 1.48 cm) with positive EUS features should receive intensive surveillance or undergo endoscopic surgery. EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.

Small Gastric Stromal Tumors: An Underestimated Risk

“…However, the cutoff size of small GISTs for endoscopic resection remains controversial. Fang et al investigated the clinical course of small GISTs and demonstrated that a cutoff value of 1.4 cm is appropriate for treatment [ 19 ], and Wang et al proposed that a tumor diameter of 1.45 cm should be the optimal cutoff value for resection, which were consistent with our other retrospective study [ 20 ] which identified that a smaller tumor diameter cutoff (1.48 cm) might have better efficacy in differentiating risk grades. Furthermore, a single-institution retrospective study of 69 patients with EUS-suspected GISTs showed that GISTs > 9.5 mm in diameter are associated with significant progression and that 23% of these patients show significant changes in size after more than 3 years of onset [ 21 ].…”

Small Gastric Stromal Tumors: An Underestimated Risk

“…However, the cutoff size of small GISTs for endoscopic resection remains controversial. Fang et al investigated the clinical course of small GISTs and demonstrated that a cutoff value of 1.4 cm is appropriate for treatment [19], and Wang et al proposed that a tumor diameter of 1.45 cm should be the optimal cutoff value for resection, which were consistent with our other retrospective study [20] which identified that a smaller tumor diameter cutoff (1.48 cm) might have better efficacy in differentiating risk grades. Furthermore, a single-institution retrospective study of 69 patients with EUSsuspected GISTs showed that GISTs > 9.5 mm in diameter are associated with significant progression and that 23% of these patients show significant changes in size after more than 3 years of onset [21].…”

Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis

“…These results indicate a substantial improvement in diagnosing gastric mesenchymal tumors with the incorporation of AI technologies. However, the diagnostic performance of AI-assisted EUS models for detecting SETs <2 cm in size was not high compared with that of SETs >2 cm in size [29], which might be because EUS characteristics of GISTs, such as marginal irregularity and cystic changes, are not often clearly discernible in small-sized GISTs [40]. This issue could be explained by previous AI-assisted EUS models focusing solely on the EUS images without considering clinical and endoscopic factors.…”

“…Gastric SETs have several clinical characteristics, such as age and tumor location, according to histopathology [20,[40][41][42][43]. Old age and location in the gastric body and fundus…”