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

Abstract

Objectives To determine CT features that can identify gastrointestinal stromal tumors (GISTs) among gastric sub-epithelial tumors (SETs) and to explore a practical scoring method. Methods Sixty-four patients with gastric SETs (51 GISTs and 13 non-GISTs) from hospital I were included for primary analyses, and 92 (67 GISTs and 25 non-GISTs) from hospital II constituted a validation cohort. Pre-operative CT images were reviewed for imaging features: lesion location, growth pattern, lesion margin, enhancement pattern, dynamic pattern, attenuation at each phasic images and presence of necrosis, superficial ulcer, calcification, and peri-lesion enlarged lymph node (LN). Clinical and CT features were compared between the two groups (GISTs versus non-GISTs) and a GIST-risk scoring method was developed; then, its performance for identifying GISTs was tested in the validation cohort. Results Seven clinical and CT features were significantly suggestive of GISTs rather than non-GISTs: older age (> 49 years), non-cardial location, irregular margin, lower attenuation on unenhanced images (≤ 43 HU), heterogeneous enhancement, necrosis, and absence of enlarged LN (p < 0.05). At validation step, the established scoring method with cut-off score dichotomized into ≥ 4 versus < 4 for identifying GISTs revealed an AUC of 0.97 with an accuracy of 92%, a sensitivity of 100% and a negative predictive value (NPV) of 100%. Conclusions Gastric GISTs have special CT and clinical features that differ from non-GISTs. With a simple and practical scoring method based on the significant features, GISTs can be accurately differentiated from non-GISTs.

Prediction of Gastric Gastrointestinal Stromal Tumors before Operation: A Retrospective Analysis of Gastric Subepithelial Tumors

“…Our results show that patients with GISTs were usually older (group 2-5, 63 years; group 5-10, 61 years), which is in agreement with previous studies [2,17,18]. The most common presentation of GISTs is bleeding-related mucosal erosion.…”

Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach

“…Such differences between the location of GISTs and leiomyomas have been reported previously. [ 9 , 10 ] In this context, the first step based on endoscopic features is reasonable for screening leiomyomas from further investigations. Our approach may also be beneficial from an econometric standpoint.…”

“…This observation of older age in patients with a GIST has been reported previously. Liu et al [ 10 ] reported that the mean age of patients with a gastric GIST diagnosis was 44.5 years and that of patients with a gastric leiomyoma diagnosis was 40.1 years. The authors proposed a scoring method for the diagnosis of GISTs using 7 clinical and CT features, including older age (>49 years), non-cardiac location, irregular margin, lower attenuation on unenhanced images (≤43 HU), heterogeneous enhancement, necrosis, and absence of enlarged lymph nodes.…”

Differential Diagnosis and Molecular Stratification of Gastrointestinal Stromal Tumors on CT Images Using a Radiomics Approach

“…Radiomics could not predict the presence and subtype of c-KIT mutations or the MI. Diagnosing GISTs is currently done manually by radiologists and confirmed through a tissue biopsy [4,38,39]. The ability to distinguish rare GISTs from non-GISTs on routine CT scans through radiomics could be a quick method for the initial assessment of intra-abdominal tumors.…”