Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study

Abstract

Background/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.Methods: We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.Results: Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.Conclusions: The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

“…The EUS imaging features of leiomyomas are similar to those of GISTs. Recently, a predictive nomogram for differentiating GIST and leiomyoma was reported [24]. The nomogram includes the following parameters: age, sex, homogeneity and anechoic space (EUS features), location in the stomach, and ulceration.…”

Results of the interim analysis of a prospective, multicenter, observational study of small subepithelial lesions in the stomach

“…GISTs virtually arise anywhere in the stomach, whereas ectopic pancreas and lipoma develop in the antrum and leiomyoma mostly occur in the cardia. [21][22][23] Despite the predominant location of each type of tumor, we revealed that no difference was observed in the rate of lesion enlargement between the locations of the subepithelial lesions (Fig. 3).…”

Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis

“…The imaging modality frequently used to evaluate SELs is the EUS because of its ability to characterize the size, echogenicity, originating layer, shape, vascularity, and location[ 1 , 3 , 35 ]. Regarding conventional EUS findings for GIST, just stronger echogenicity in comparison with the surrounding muscle echo is an associated independent diagnostic factor[ 31 ].…”