Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2806
Peer-review started: March 28, 2018
First decision: May 9, 2018
Revised: June 3, 2018
Accepted: June 22, 2018
Article in press: June 22, 2018
Published online: July 14, 2018
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.
Core tip: Potentially malignant gastrointestinal stromal tumors are the most common subepithelial lesions (SELs) of the gastrointestinal tract. SELs include a broader range of differential diagnoses from benign to malignant lesions. The possibility of having a malignant lesion may cause anxiety and discomfort in patients and gastroenterologists. Early and accurate diagnosis of SELs using endoscopic ultrasonography (EUS) and/or EUS-guided fine needle aspiration is vital to guide selection of early appropriate management.