Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2022; 28(37): 5457-5468
Published online Oct 7, 2022. doi: 10.3748/wjg.v28.i37.5457
Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors
Qi-Chao Ge, Yu-Fan Wu, Zi-Ming Liu, Zhe Wang, Sheng Wang, Xiang Liu, Nan Ge, Jin-Tao Guo, Si-Yu Sun
Qi-Chao Ge, Yu-Fan Wu, Zi-Ming Liu, Sheng Wang, Xiang Liu, Nan Ge, Jin-Tao Guo, Si-Yu Sun, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Zhe Wang, Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Ge QC wrote a majority portion of manuscript, prepared the figures and tables, and performed statistical analysis; Wu YF collected the data of patients; Liu ZM helped with the statistical analysis and manuscript writing; Wang Z provided and confirmed the pathological data of all the patients; Wang S, Liu X, and Ge N took part in the design of the study outline and performed tumor dissection; Guo JT and Sun SY were responsible for the revision of the manuscript for important intellectual content and supervised the study; all the authors read and gave their final approval for the manuscript to be submitted.
Supported by National Natural Science Foundation of China, No. 81900601; The University Innovation Team and Innovative Talent Support Program of Liaoning Province, No. LR2019073; and Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program, No. RC200438.
Institutional review board statement: This study was approved by the Ethics Review Committee of Shengjing Hospital of China Medical University, No. 2022PS009K.
Informed consent statement: All the individual involved gave their informed consent prior to study inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Tao Guo, MD, PhD, Professor, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. guojt@sj-hospital.org
Received: June 22, 2022
Peer-review started: June 22, 2022
First decision: September 2, 2022
Revised: September 14, 2022
Accepted: September 20, 2022
Article in press: September 20, 2022
Published online: October 7, 2022
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.

Keywords: Gastrointestinal stromal tumors, Endoscopic ultrasound, Diagnosis, Risk classification

Core Tip: Endoscopic ultrasound (EUS) has been the recommended follow-up method for small gastrointestinal stromal tumors (GISTs); however, it is not clear whether positive EUS features can predict the malignant potential of small GISTs. Besides, undergoing close follow-up is an economic and mental burden on patients with small GISTs. This study illustrates an optimal cut-off value for the tumor size (1.48 cm) of small GISTs and uses heterogeneity to evaluate risk prediction. Overall, small GISTs with diameters > 1.48 cm with positive EUS features should receive more intensive follow-up or undergo endoscopic surgery.