The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors

Gao, Zhidong; Wang, Chao; Xue, Qiao; Wang, Jingtong; Shen, Zhanlong; Jiang, Kewei; Shen, Kai; Liang, Bin; Yang, Xiaodong; Xie, Qin; Wang, Shan; Ye, Yingjiang

doi:10.1186/s12876-016-0567-4

Cited by 34 publications

(33 citation statements)

References 21 publications

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“…If EUS imaging of a SEL with an endoscopically negative biopsy shows a hypoechoic solid mass of > 1 cm, subsequent EUS-FNA is needed to obtain a conclusive tissue diagnosis of a GIST[ 21 , 56 ]. Small SELs of < 1 cm are currently recommended to undergo periodic EUS follow-up (every 6 mo or 1 year)[ 56 , 91 ] because EUS-FNA for small SELs of < 1 cm is technically difficult. These aggressive approaches for early diagnosis and early treatment of small SELs, similar to the approaches for gastrointestinal tract cancer, seem to be the only promising way to improve patients’ quality of life and prognosis.…”

Section: Management Of Small Sels Suspected To Be Gistsmentioning

confidence: 99%

Current clinical management of gastrointestinal stromal tumor

Akahoshi

Oya

Koga

et al. 2018

WJG

300

279

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Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

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Section: Management Of Small Sels Suspected To Be Gistsmentioning

confidence: 99%

Current clinical management of gastrointestinal stromal tumor

Akahoshi

Oya

Koga

et al. 2018

WJG

300

279

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“…Most of small GISTs were discovered incidentally. Although most small GIST or micro-GIST show benign or indolent clinical course, there are still very few cases showing aggressive behavior, especially those tumors with high mitotic counts ( 26 ).…”

Section: Principles Of Pathologic Diagnosismentioning

confidence: 99%

Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor

Li¹,

Ye²,

Wang³

et al. 2017

Chinese Journal of Cancer Research

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154

145

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In order to further promote the standardization of diagnosis and treatment of gastrointestinal stromal tumor (GIST) in China, the members of Chinese Society of Clinical Oncology (CSCO) Expert Committee on GIST thoroughly discussed the key contents of the consensus guidelines, and voted on the controversial issue. In final, the Chinese consensus guidelines for the diagnosis and management of GIST (2017 edition) was formed on the basis of 2013 edition consensus guidelines, which is hereby announced. The consensus included the pathological diagnosis, recurrence risk classification evaluation, targeted agent therapy, surgery and principles of surveillance of GIST.

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“…However, studies found that some GGs < 2 cm would enlarge after years of follow-up. 26,27 biomarker to evaluate the effect of therapy and postoperative surveillance. Small GGs are often negative on CT scans and endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Serum Pepsinogen as a Biomarker of Gastrointestinal Stromal Tumors (GIST) in Stomach

Zhou

gao

Luo

et al. 2021

Preprint

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BackgroundNo biomarker was identified for gastric GISTs(GG) detection. We first observed that glands surrounding GG are regionally atrophic. We hypothesize that this local atrophy may mildly reduce pepsinogen Ⅰ(PGⅠ) but the PGⅠ/PGII ratio remains normal. To test our hypothesis, a retrospective analysis was conducted to evaluate the diagnostic efficiency of PG in GG detection.MethodsWe retrospectively analyzed a cohort of consecutive GG and gastric cancer(GC) patients at our center. Pathologic confirmed GG patients and GC patients with tested PG levels before medical intervention were included. Three criteria were assessed: 1.Serum PGI≤70ng/ml; 2.Positive-Gastric-GIST-PG(PGⅠ≤70 ng/ml and PGI/PGII ratio>3.0); and 3.Positive-Gastric-GIST-PG-CEA(Positive-Gastric-GIST-PG plus normal CEA). Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and overall accuracy(OA) were calculated. A Chi-square test was applied to detect the differences.ResultsAfter screened 562 GG and 1090 GC, 100 GG and 174 GC samples were included. For PGI≤70ng/ml, the Positive-Gastric-GIST-PG and the Positive-Gastric-GIST-PG-CEA criteria discriminating GG from GC, the sensitivities were 75%(95%CI 66-82),70%(60-78) and 68%(58-76), respectively; the specificities were 50%(43-57), 70%(62-76), and 78%(71-83), respectively; the PPV were 46%(39-54), 57%(48-65), and 64%(55-73), respectively; the NPV were 78%(69-84), 80%(73-86), 81%(74-86), respectively; and the OA were 59%(53-65), 70%(64-75), and 74%(69-79), respectively. There was statistic difference in sensitivities between GG and GC for Positive-Gastric-GIST-PG-CEA criterion(68% for GG vs. 22% for GC, P<0.0001). ConclusionSerum PGs are useful for both detecting GG and distinguishing GG from GC. Integrating our criteria into current PG test scheme of gastric precancerous screening will be helpful for early GG detection without additional economic expense.

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The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors

Cited by 34 publications

References 21 publications

Current clinical management of gastrointestinal stromal tumor

Current clinical management of gastrointestinal stromal tumor

Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor

Serum Pepsinogen as a Biomarker of Gastrointestinal Stromal Tumors (GIST) in Stomach

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