1
|
Gabellone S, Vanni S, Fausti V, Miserocchi G, Liverani C, Spadazzi C, Cocchi C, Calabrese C, Cavaliere D, Pacilio CA, Ercolani G, Pieri F, Gurrieri L, Riva N, Jones R, De Vita A. Exploring nanotechnology solutions for improved outcomes in gastrointestinal stromal tumors. Heliyon 2024; 10:e40596. [PMID: 39687122 PMCID: PMC11647801 DOI: 10.1016/j.heliyon.2024.e40596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 11/19/2024] [Accepted: 11/20/2024] [Indexed: 12/18/2024] Open
Abstract
Objectives Gastrointestinal stromal tumors, the most prevalent mesenchymal tumors (80 %) of the gastrointestinal tract, comprise less than 1 % of all gastrointestinal neoplasms and about 5 % of all sarcomas. Despite their rarity, Gastrointestinal stromal tumors present diverse clinical manifestations, anatomic locations, histological subtypes, and prognostic outcomes. Methods This scoping review comprehensively explores the epidemiology, clinical characteristics, diagnostic and prognostic modalities, as well as new therapeutic options for Gastrointestinal stromal tumors. Results A particular focus is placed on the promising role of bio-nanomaterials as multifunctional agents for drug delivery and 3D tumor microenvironment modeling. Bio-nanomaterials offer promising opportunities for targeted drug delivery, overcoming treatment resistance, and improving therapeutic efficacy. Conclusion Despite significant advancements, Gastrointestinal stromal tumors remain a complex clinical entity with ongoing challenges. The integration of nanotechnology into Gastrointestinal stromal tumors management offers the potential to enhance patient outcomes. Future studies should prioritize the development and evaluation of nanomaterial-based therapies in clinical trials to facilitate the translation of laboratory discoveries into real-world clinical applications.
Collapse
Affiliation(s)
- Sofia Gabellone
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Silvia Vanni
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Valentina Fausti
- Clinical and Experimental Oncology, Immunotherapy, Rare Cancers and Biological Resource Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Giacomo Miserocchi
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Chiara Liverani
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Chiara Spadazzi
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Claudia Cocchi
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Chiara Calabrese
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Davide Cavaliere
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121, Forlì, Italy
| | | | - Giorgio Ercolani
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121, Forlì, Italy
| | - Federica Pieri
- Pathology Unit, “Morgagni-Pierantoni” Hospital, 47121, Forlì, Italy
| | - Lorena Gurrieri
- Clinical and Experimental Oncology, Immunotherapy, Rare Cancers and Biological Resource Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Nada Riva
- Clinical and Experimental Oncology, Immunotherapy, Rare Cancers and Biological Resource Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| | - Robin Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, SW3 6JJ, London, UK
| | - Alessandro De Vita
- Preclinic and Osteoncology Unit, Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014, Meldola, Italy
| |
Collapse
|
2
|
Nishida T, Gotouda N, Takahashi T, Cao H. Clinical importance of tumor rupture in gastrointestinal stromal tumor. J Dig Dis 2024; 25:542-549. [PMID: 37210619 DOI: 10.1111/1751-2980.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/22/2023]
Abstract
Risk factors of gastrointestinal stromal tumors (GISTs) include tumor size, location, mitosis, and tumor rupture. Although the first three are commonly recognized as independent prognostic factors, tumor rupture is not a consistent finding. Indeed, tumor rupture may be subjectively diagnosed and is rarely observed. Moreover, the criteria used for diagnosis differ among oncologists, which may result in inconsistent outcomes. Based on these conditions, a universal definition of tumor rupture was proposed in 2019 and consists of six scenarios: tumor fracture, blood-stained ascites, gastrointestinal perforation at the tumor site, histologically proven invasion, piecemeal resection, and open incisional biopsy. Although the definition is considered appropriate for selection of GISTs with worse prognostic outcomes, each scenario lacks a high level of evidence and there is yet no consensus for some, including histological invasion and incisional biopsy. It may be, however, important to have common criteria for clinical decision-making, which may facilitate reliability, external validity, and comparability of clinical studies in rare GISTs. After the definition, several retrospective reports indicated that even with adjuvant therapy, tumor rupture was associated with high recurrence rates and poor prognostic outcomes. The prognosis of patients with ruptured GISTs is improved by 5-year adjuvant therapy compared with 3-year therapy. Nevertheless, the universal definition requires further evidence, and prospective clinical studies based on the definition are warranted.
Collapse
Affiliation(s)
- Toshirou Nishida
- Department of Surgery, Japan Community Health-care Organization Osaka Hospital, Osaka, Japan
- Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
- Laboratory of Nuclear Transport Dynamics, National Institute of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka, Japan
| | - Naoto Gotouda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka, Japan
| | - Hui Cao
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
3
|
Che X, Yang C, Pan L, Gu D, Dai G, Shu J, Yang L. Achieving safe and high-performance gastrointestinal tract spectral CT imaging with small-molecule lanthanide complex. Biomater Res 2023; 27:119. [PMID: 37990349 PMCID: PMC10664581 DOI: 10.1186/s40824-023-00463-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Non-intrusive imaging of gastrointestinal (GI) tract using computed tomography (CT) contrast agents is of the most significant issues in the diagnosis and treatment of GI diseases. Moreover, spectral CT, which can generate monochromatic images to display the X-ray attenuation characteristics of contrast agents, provides a better imaging sensitivity for diagnose inflammatory bowel disease (IBD) than convention CT imaging. METHODS Herein, a convenient and one-pot synthesis method is provided for the fabrication of small-molecule lanthanide complex Holmium-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (Ho-DOTA) as a biosafe and high-performance spectral CT contrast agent for GI imaging with IBD. In vivo CT imaging was administered with both healthy mice and colitis mice induced by dextran sodium sulfate. RESULTS We found that Ho-DOTA accumulated in inflammation sites of large intestines and produced high CT contrast compared with healthy mice. Both in vitro and in vivo experimental results also showed that Ho-DOTA provided much more diagnostic sensitivity and accuracy due to the excellent X-ray attenuation characteristics of Ho-DOTA compared with clinical iodinate agent. Furthermore, the proposed contrast media could be timely excreted from the body via the urinary and digestive system, keeping away from the potential side effects due to long-term retention in vivo. CONCLUSION Accordingly, Ho-DOTA with excellent biocompatibility can be useful as a potential high-performance spectral CT contrast agent for further clinical imaging of gastrointestinal tract and diagnosis of intestinal system diseases.
Collapse
Affiliation(s)
- Xiaoling Che
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Chunmei Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Liping Pan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Didi Gu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Guidong Dai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.
| | - Lu Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.
| |
Collapse
|
4
|
Wang TT, Liu WW, Liu XH, Gao RJ, Zhu CY, Wang Q, Zhao LP, Fan XM, Li J. Relationship between multi-slice computed tomography features and pathological risk stratification assessment in gastric gastrointestinal stromal tumors. World J Gastrointest Oncol 2023; 15:1073-1085. [PMID: 37389110 PMCID: PMC10303000 DOI: 10.4251/wjgo.v15.i6.1073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/02/2023] [Accepted: 04/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Computed tomography (CT) imaging features are associated with risk stratification of gastric gastrointestinal stromal tumors (GISTs).
AIM To determine the multi-slice CT imaging features for predicting risk stratification in patients with primary gastric GISTs.
METHODS The clinicopathological and CT imaging data for 147 patients with histologically confirmed primary gastric GISTs were retrospectively analyzed. All patients had received dynamic contrast-enhanced CT (CECT) followed by surgical resection. According to the modified National Institutes of Health criteria, 147 lesions were classified into the low malignant potential group (very low and low risk; 101 lesions) and high malignant potential group (medium and high-risk; 46 lesions). The association between malignant potential and CT characteristic features (including tumor location, size, growth pattern, contour, ulceration, cystic degeneration or necrosis, calcification within the tumor, lymphadenopathy, enhancement patterns, unenhanced CT and CECT attenuation value, and enhancement degree) was analyzed using univariate analysis. Multivariate logistic regression analysis was performed to identify significant predictors of high malignant potential. The receiver operating curve (ROC) was used to evaluate the predictive value of tumor size and the multinomial logistic regression model for risk classification.
RESULTS There were 46 patients with high malignant potential and 101 with low-malignant potential gastric GISTs. Univariate analysis showed no significant differences in age, gender, tumor location, calcification, unenhanced CT and CECT attenuation values, and enhancement degree between the two groups (P > 0.05). However, a significant difference was observed in tumor size (3.14 ± 0.94 vs 6.63 ± 3.26 cm, P < 0.001) between the low-grade and high-grade groups. The univariate analysis further revealed that CT imaging features, including tumor contours, lesion growth patterns, ulceration, cystic degeneration or necrosis, lymphadenopathy, and contrast enhancement patterns, were associated with risk stratification (P < 0.05). According to binary logistic regression analysis, tumor size [P < 0.001; odds ratio (OR) = 26.448; 95% confidence interval (CI): 4.854-144.099)], contours (P = 0.028; OR = 7.750; 95%CI: 1.253-47.955), and mixed growth pattern (P = 0.046; OR = 4.740; 95%CI: 1.029-21.828) were independent predictors for risk stratification of gastric GISTs. ROC curve analysis for the multinomial logistic regression model and tumor size to differentiate high-malignant potential from low-malignant potential GISTs achieved a maximum area under the curve of 0.919 (95%CI: 0.863-0.975) and 0.940 (95%CI: 0.893-0.986), respectively. The tumor size cutoff value between the low and high malignant potential groups was 4.05 cm, and the sensitivity and specificity were 93.5% and 84.2%, respectively.
CONCLUSION CT features, including tumor size, growth patterns, and lesion contours, were predictors of malignant potential for primary gastric GISTs.
Collapse
Affiliation(s)
- Tian-Tian Wang
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Wei-Wei Liu
- Department of Rheumatology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Xian-Hai Liu
- Department of Network Information Center, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Rong-Ji Gao
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Chun-Yu Zhu
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Qing Wang
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Lu-Ping Zhao
- Department of Medical Imaging, The Affiliated Hospital of Ji’ning Medical University, Jining 272000, Shandong Province, China
| | - Xiao-Ming Fan
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Juan Li
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| |
Collapse
|
5
|
Khan J, Ullah A, Waheed A, Karki NR, Adhikari N, Vemavarapu L, Belakhlef S, Bendjemil SM, Mehdizadeh Seraj S, Sidhwa F, Ghleilib I, Foroutan S, Blakely AM, Del Rivero J, Karim NA, Vail E, Heneidi S, Mesa H. Gastrointestinal Stromal Tumors (GIST): A Population-Based Study Using the SEER Database, including Management and Recent Advances in Targeted Therapy. Cancers (Basel) 2022; 14:3689. [PMID: 35954353 PMCID: PMC9367571 DOI: 10.3390/cancers14153689] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) system. Most GISTs originate from the interstitial cells of Cajal (ICC), the pacemaker cell situated between the circular and longitudinal layers of the muscularis propria along the GI tract. In this population-based study using the SEER database, we sought to identify demographic, clinical, and pathologic factors that affect the prognosis and survival of patients with this neoplasm. Molecular genetic advances, current management guidelines, and advances in targeted therapy are discussed. Methods: Demographic and clinical data from GIST patients were retrieved from the SEER research plus database for the period 2000−2018. Statistical analysis was performed with IBM SPSS® v20.2 software using the Chi-square test, paired t-test, multivariate analysis, and Kaplan−Meier functions. Results: A total of 10,833 patients with GIST were identified. Most patients were between 60−74 years of age: 40%, Caucasian: 68%, and the male to female ratio was 1.1:1. The most common primary tumor sites were stomach: 63%, small intestine: 30%, rectum: 3%, and esophagus: 0.7%. When reported, the grade of differentiation was well: 38%, moderately: 32%, undifferentiated: 19%, poorly: 12%. The size of most tumors ranged between 6−10 cm: 36% and they were treated by surgical intervention: 82% and/or chemotherapy/targeted therapy: 39%. The stage was localized: 66%, advanced: 19%, and regional: 15%. The 5-year survival was 74% (95% confidence interval (95% CI) = 72.6−74.7), and the 5-year cause-specific survival 82% (95% CI = 80.7−82.6). The 5-year cause-specific survival by treatment included surgery at 86% (95% CI = 85.4−87.3), chemotherapy/targeted therapy with or without surgery at 77% (95% CI = 75.7−78.9), and radiation at 75% (95% CI = 74.5−80). On multivariable analysis tumor size > 5 cm, poorly and undifferentiated grade, age > 60, and distant metastases at presentation were associated with worse overall survival. Conclusion: GISTs comprise 1−2% of malignancies of the GI tract, usually affect male Caucasians between the ages of 60 and 74 years, most tumors occur in the stomach and small intestine, and are usually >5 cm, but still localized, at the time of diagnosis. Most tumors receive multimodality surgical and chemotherapy/targeted therapy treatment, with a 5-year overall survival of 74% and cause-specific survival of 82%. GIST patients would benefit from enrollment in large clinical trials to establish better therapy guidelines for unresectable, treatment-refractory, and recurrent tumors.
Collapse
Affiliation(s)
- Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Asad Ullah
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (S.M.B.); (S.M.S.); (F.S.); (S.F.)
| | - Nabin Raj Karki
- Georgia Cancer Center, Department of Hematology Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Nawaraj Adhikari
- Department of Medicine, Bon Secours Memorial Regional Medical Center, Mechanicsville, VA 23116, USA;
| | - Lakshmi Vemavarapu
- Department of Pathology, Charlie Norwood Veterans Affairs Medical Center, Augusta, GA 30904, USA;
| | - Sami Belakhlef
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (S.B.); (I.G.)
| | - Samy Malik Bendjemil
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (S.M.B.); (S.M.S.); (F.S.); (S.F.)
| | - Siamak Mehdizadeh Seraj
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (S.M.B.); (S.M.S.); (F.S.); (S.F.)
| | - Feroze Sidhwa
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (S.M.B.); (S.M.S.); (F.S.); (S.F.)
| | - Intisar Ghleilib
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (S.B.); (I.G.)
| | - Shahin Foroutan
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (S.M.B.); (S.M.S.); (F.S.); (S.F.)
| | - Andrew M. Blakely
- National Cancer Institute (NCI), Bethesda, MD 20892, USA; (A.M.B.); (J.D.R.)
| | - Jaydira Del Rivero
- National Cancer Institute (NCI), Bethesda, MD 20892, USA; (A.M.B.); (J.D.R.)
| | - Nagla Abdel Karim
- Inova Schar Cancer Institute, Department of Medicine, University of Virginia, Fairfax, VA 22031, USA;
| | - Eric Vail
- Molecular Pathology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (E.V.); (S.H.)
| | - Saleh Heneidi
- Molecular Pathology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (E.V.); (S.H.)
| | - Hector Mesa
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| |
Collapse
|
6
|
Inoue A, Ota S, Yamasaki M, Batsaikhan B, Furukawa A, Watanabe Y. Gastrointestinal stromal tumors: a comprehensive radiological review. Jpn J Radiol 2022; 40:1105-1120. [PMID: 35809209 DOI: 10.1007/s11604-022-01305-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) originating from the interstitial cells of Cajal in the muscularis propria are the most common mesenchymal tumor of the gastrointestinal tract. Multiple modalities, including computed tomography (CT), magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography, ultrasonography, digital subtraction angiography, and endoscopy, have been performed to evaluate GISTs. CT is most frequently used for diagnosis, staging, surveillance, and response monitoring during molecularly targeted therapy in clinical practice. The diagnosis of GISTs is sometimes challenging because of the diverse imaging findings, such as anatomical location (esophagus, stomach, duodenum, small bowel, colorectum, appendix, and peritoneum), growth pattern, and enhancement pattern as well as the presence of necrosis, calcification, ulceration, early venous return, and metastasis. Imaging findings of GISTs treated with antineoplastic agents are quite different from those of other neoplasms (e.g. adenocarcinomas) because only subtle changes in size are seen even in responsive lesions. Furthermore, the recurrence pattern of GISTs is different from that of other neoplasms. This review discusses the advantages and disadvantages of each imaging modality, describes imaging findings obtained before and after treatment, presents a few cases of complicated GISTs, and discusses recent investigations performed using CT and MRI to predict histological risk grade, gene mutations, and patient outcomes.
Collapse
Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan. .,Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - Shinichi Ota
- Department of Radiology, Nagahama Red Cross Hospital, Shiga, Japan
| | - Michio Yamasaki
- Department of Radiology, Kohka Public Hospital, Shiga, Japan
| | - Bolorkhand Batsaikhan
- Graduate School of Human Health Sciences, Department of Radiological Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Akira Furukawa
- Graduate School of Human Health Sciences, Department of Radiological Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| |
Collapse
|
7
|
Gastrointestinal Stromal Tumours: Preoperative Imaging Features to Predict Recurrence after Curative Resection. Eur J Radiol 2022; 149:110193. [DOI: 10.1016/j.ejrad.2022.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
|
8
|
Yang CW, Liu XJ, Zhao L, Che F, Yin Y, Chen HJ, Zhang B, Wu M, Song B. Preoperative prediction of gastrointestinal stromal tumors with high Ki-67 proliferation index based on CT features. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1556. [PMID: 34790762 PMCID: PMC8576677 DOI: 10.21037/atm-21-4669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To determine whether preoperative computed tomography (CT) features can be used for the prediction of gastrointestinal stromal tumors (GISTs) with a high Ki-67 proliferation index (Ki-67 PI). METHODS A total of 198 patients with surgically and pathologically proven GISTs were retrospectively included. All GISTs were divided into a low Ki-67 PI group (<10%) and a high Ki-67 PI group (≥10%). All imaging features were blindly interpreted by two radiologists. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive performance of the imaging features. RESULTS Imaging features were found to be significantly different between the low and the high Ki-67 PI groups (P<0.05). Wall thickness of necrosis showed the highest predictive ability, with an area under the curve (AUC) of 0.838 [95% confidence interval (CI): 0.627-0.957], followed by necrosis, necrosis degree, hyperenhancement of the overlying mucosa (HYOM), and long diameter (LD) (AUC >0.7, P<0.05). HYOM was the strongest predictive feature for the high Ki-67 PI GISTs group, with an odds ratio (OR) value of 30.037 (95% CI: 5.707-158.106). CONCLUSIONS Imaging features, including the presence of necrosis, high necrosis degree, thick wall of necrosis, and HYOM were significant predictive indicators for the high Ki-67 PI GISTs group.
Collapse
Affiliation(s)
- Cai-Wei Yang
- West China School of Medicine, Sichuan University, Chengdu, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lian Zhao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Che
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Jiao Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Clinic Medical Center, Dazhou Central Hospital, Dazhou, China
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, CA, USA
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Assessment of morphological CT imaging features for the prediction of risk stratification, mutations, and prognosis of gastrointestinal stromal tumors. Eur Radiol 2021; 31:8554-8564. [PMID: 33881567 DOI: 10.1007/s00330-021-07961-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the correlation between CT imaging features and risk stratification of gastrointestinal stromal tumors (GISTs), prediction of mutation status, and prognosis. METHODS This retrospective dual-institution study included patients with pathologically proven GISTs meeting the following criteria: (i) preoperative contrast-enhanced CT performed between 2008 and 2019; (ii) no treatments before imaging; (iii) available pathological analysis. Tumor risk stratification was determined according to the National Institutes of Health (NIH) 2008 criteria. Two readers evaluated the CT features, including enhancement patterns and tumor characteristics in a blinded fashion. The differences in distribution of CT features were assessed using univariate and multivariate analyses. Survival analyses were performed by using the Cox proportional hazard model, Kaplan-Meier method, and log-rank test. RESULTS The final population included 88 patients (59 men and 29 women, mean age 60.5 ± 11.1 years) with 45 high-risk and 43 low-to-intermediate-risk GISTs (median size 6.3 cm). At multivariate analysis, lesion size ≥ 5 cm (OR: 10.52, p = 0.009) and enlarged feeding vessels (OR: 12.08, p = 0.040) were independently associated with the high-risk GISTs. Hyperenhancement was significantly more frequent in PDGFRα-mutated/wild-type GISTs compared to GISTs with KIT mutations (59.3% vs 23.0%, p = 0.004). Ill-defined margins were associated with shorter progression-free survival (HR 9.66) at multivariate analysis, while ill-defined margins and hemorrhage remained independently associated with shorter overall survival (HR 44.41 and HR 30.22). Inter-reader agreement ranged from fair to almost perfect (k: 0.32-0.93). CONCLUSIONS Morphologic contrast-enhanced CT features are significantly different depending on the risk status or mutations and may help to predict prognosis. KEY POINTS • Lesions size ≥ 5 cm (OR: 10.52, p = 0.009) and enlarged feeding vessels (OR: 12.08, p = 0.040) are independent predictors of high-risk GISTs. • PDGFRα-mutated/wild-type GISTs demonstrate more frequently hyperenhancement compared to GISTs with KIT mutations (59.3% vs 23.0%, p = 0.004). • Ill-defined margins (hazard ratio 9.66) were associated with shorter progression-free survival at multivariate analysis, while ill-defined margins (hazard ratio 44.41) and intralesional hemorrhage (hazard ratio 30.22) were independently associated with shorter overall survival.
Collapse
|
10
|
Yang CW, Liu XJ, Liu SY, Wan S, Ye Z, Song B. Current and Potential Applications of Artificial Intelligence in Gastrointestinal Stromal Tumor Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:6058159. [PMID: 33304203 PMCID: PMC7714601 DOI: 10.1155/2020/6058159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/18/2020] [Accepted: 10/31/2020] [Indexed: 02/05/2023]
Abstract
The most common mesenchymal tumors are gastrointestinal stromal tumors (GISTs), which have malignant potential and can occur anywhere along the gastrointestinal system. Imaging methods are important and indispensable of GISTs in diagnosis, risk staging, therapy, and follow-up. The recommended imaging method for staging and follow-up is computed tomography (CT) according to current guidelines. Artificial intelligence (AI) applies and elaborates theses, procedures, modes, and utilization systems for simulating, enlarging, and stretching the intellectual capacity of humans. Recently, researchers have done a few studies to explore AI applications in GIST imaging. This article reviews the present AI studies in GISTs imaging, including preoperative diagnosis, risk stratification and prediction of prognosis, gene mutation, and targeted therapy response.
Collapse
Affiliation(s)
- Cai-Wei Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Si-Yun Liu
- GE Healthcare (China), Beijing 100176, China
| | - Shang Wan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
11
|
Peng G, Huang B, Yang X, Pang M, Li N. Preoperative CT feature of incomplete overlying enhancing mucosa as a high-risk predictor in gastrointestinal stromal tumors of the stomach. Eur Radiol 2020; 31:3276-3285. [PMID: 33125563 DOI: 10.1007/s00330-020-07377-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether the CT finding of overlying enhancing gastric mucosa (OEGM) can be used to predict risk stratifications by observing CT features of gastrointestinal stromal tumors (GISTs) of the stomach. METHODS Clinical characteristics and CT features within pathologically demonstrated GISTs were retrospectively reviewed. Risk stratifications were classified into non-high group and high-risk group according to the modified National Institutes of Health criteria. Univariate analysis and multivariate logistic regression analysis were performed in order to determine significant predictors for high-risk stratification. Receiver operating characteristic (ROC) curve analysis, subgroup analysis, and pathologic-radiologic correlation analysis were all executed. RESULTS A total of 147 patients were finally enrolled as test subjects. Within the univariate analysis, high-risk tumors tended to have a larger diameter, irregular shape, exophytic growth pattern, present necrosis, incomplete OEGM, tumor vessels, heterogeneous enhancement, and present rupture. According to ROC curve analysis, incomplete OEGM showed the largest area under curve values for diagnosing lesions (0.835; 95% CI, 0.766-0.904; p < 0.001). Multivariate analysis showed that the incomplete OEGM was the strongest independent predictor for high-risk stratification of gastric GISTs (OR = 21.944; 95% CI, 4.344-110.863; p < 0.001). Within the subgroup analysis, incomplete OEGM was more frequently associated with tumors size > 10 cm, irregular shape, exophytic growth pattern, high mitotic count, and disrupted mucosa on pathology. CONCLUSIONS The CT feature of incomplete OEGM is an independent predictive factor for high-risk stratification of gastric GISTs and strongly correlated with pathological mucosal changes. KEY POINTS • Preoperative CT features can be helpful in assessment of risk stratifications of gastric GISTs. • OEGM is an independent predictor for high-risk stratification of gastric GISTs. • Incomplete OEGM likely indicates high-risk stratification of gastric GISTs.
Collapse
Affiliation(s)
- Gang Peng
- Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China
| | - Bingcang Huang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Xiaodan Yang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Maohua Pang
- Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China
| | - Na Li
- Department of Ultrasound and Radiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Road, Saertu District, Daqing, 163000, Heilongjiang, China.
| |
Collapse
|
12
|
Gao L, Tang X, Qu H, He Q, Sun G, Shi J, Ye J, Liang Y. Primary gastric squamous cell carcinoma presenting as a large submucosal mass: A case report and literature review. Medicine (Baltimore) 2020; 99:e22125. [PMID: 32899097 PMCID: PMC7478421 DOI: 10.1097/md.0000000000022125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
RATIONALE Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear. PATIENT CONCERNS A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation. DIAGNOSES The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC. INTERVENTIONS Total gastrectomy, distal pancreatectomy, and splenectomy were performed. OUTCOMES The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery. LESSONS Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.
Collapse
Affiliation(s)
- Lei Gao
- Qilu Medical College of Shandong University
| | - Xiaolong Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Hui Qu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Guorui Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan China
| | - Jingbo Shi
- Qilu Medical College of Shandong University
| | | | | |
Collapse
|
13
|
Inoue A, Ota S, Nitta N, Murata K, Shimizu T, Sonoda H, Tani M, Ban H, Inatomi O, Ando A, Kushima R, Watanabe Y. Difference of computed tomographic characteristic findings between gastric and intestinal gastrointestinal stromal tumors. Jpn J Radiol 2020; 38:771-781. [PMID: 32246352 DOI: 10.1007/s11604-020-00962-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE We aimed to compare the computed tomography (CT) imaging differences between gastric and intestinal gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS Thirty-eight patients with 38 gastric GISTs and 27 with 31 intestinal GISTs were enrolled. Tumors were classified as small (< 5 cm) or large (≥ 5 cm). Qualitative and quantitative CT imaging characteristics on non-contrast and contrast-enhanced CT were evaluated by two radiologists independently and statistically compared. RESULTS Early venous return and higher CT number of the draining vein in the arterial phase were more frequent in small-sized intestinal GISTs than in small-sized gastric GISTs (p < 0.001). Small-sized intestinal GISTs demonstrated a wash-out pattern, whereas small-sized gastric GISTs showed a plateau pattern. Contrast enhancement was higher in small-sized intestinal GISTs than in small-sized gastric GISTs (p < 0.001). CT number was inversely proportional to the diameter of intestinal GISTs in both arterial and venous phases but not to that of gastric GISTs. CONCLUSION Strong enhancement with wash-out pattern and early venous return are characteristic findings of small-sized intestinal GISTs. Radiologists should be aware that CT findings of GISTs have a wide spectrum and may differ according to size and site of origin.
Collapse
Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiromichi Sonoda
- Department of Surgery, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Ban
- Department of Gastroenterology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Osamu Inatomi
- Department of Gastroenterology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Akira Ando
- Department of Gastroenterology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| |
Collapse
|
14
|
Wei SC, Xu L, Li WH, Li Y, Guo SF, Sun XR, Li WW. Risk stratification in GIST: shape quantification with CT is a predictive factor. Eur Radiol 2020; 30:1856-1865. [PMID: 31900704 PMCID: PMC7062662 DOI: 10.1007/s00330-019-06561-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/19/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022]
Abstract
Background Tumor shape is strongly associated with some tumor’s genomic subtypes and patient outcomes. Our purpose is to find the relationship between risk stratification and the shape of GISTs. Methods A total of 101 patients with primary GISTs were confirmed by pathology and immunohistochemistry and underwent enhanced CT examination. All lesions’ pathologic sizes were 1 to 10 cm. Points A and B were the extremities of the longest diameter (LD) of the tumor and points C and D the extremities of the small axis, which was the longest diameter perpendicular to AB. The four angles of the quadrangle ABCD were measured and each angle named by its summit (A, B, C, D). For regular lesions, we took angles A and B as big angle (BiA) and small angle (SmA). For irregular lesions, we compared A/B ratio and D/C ratio and selected the larger ratio for analysis. The chi-square test, t test, ROC analysis, and hierarchical or binary logistic regression analysis were used to analyze the data. Results The BiA/SmA ratio was an independent predictor for risk level of GISTs (p = 0.019). With threshold of BiA at 90.5°, BiA/SmA ratio at 1.35 and LD at 6.15 cm, the sensitivities for high-risk GISTs were 82.4%, 85.3%, and 83.8%, respectively; the specificities were 87.1%, 71%, and 77.4%, respectively; and the AUCs were 0.852, 0.818, and 0.844, respectively. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could (p < 0.05). Shape and Ki-67 were independent predictors of the mitotic value (p = 0.036 and p < 0.001, respectively), and the accuracy was 87.8%. Conclusions Quantifying tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs, especially for high-risk grading and mitotic value > 5/50HPF. Key Points • The BiA/SmA ratio was an independent predictor affecting the risk level of GISTs. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could. • Shape and Ki-67 were independent predictors of the mitotic value. • The method for quantifying the tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs.
Collapse
Affiliation(s)
- Sheng-Cai Wei
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Liang Xu
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Wan-Hu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Yun Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Shou-Fang Guo
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Xiao-Rong Sun
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China.
| | - Wen-Wu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No 440 Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China.
| |
Collapse
|
15
|
Yoo J, Kim SH, Han JK. Multiparametric MRI and 18F-FDG PET features for differentiating gastrointestinal stromal tumors from benign gastric subepithelial lesions. Eur Radiol 2019; 30:1634-1643. [PMID: 31781931 DOI: 10.1007/s00330-019-06534-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate whether multiparametric magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET) can be helpful in differentiating gastrointestinal stromal tumors (GISTs) from non-GISTs and high-risk GISTs from low-risk GISTs. METHODS This retrospective study included 56 patients with pathologically confirmed GISTs (n = 39), leiomyoma (n = 8), schwannoma (n = 5), heterotopic pancreas (n = 3), and glomus tumor (n = 1) who underwent MRI and/or PET examinations. Two radiologists reviewed MRI regarding location, shape, contour, growth pattern, margin, signal intensity (SI) on T1- (T1WI) and T2-weighted images (T2WI), degree and pattern of enhancement, hemorrhage, and necrosis. Mean apparent diffusion coefficient (ADC) and maximum standardized uptake value (SUVmax) were measured. Imaging features were compared among non-GISTs, low-risk GISTs, and high-risk GISTs using uni- and multivariate statistical analyses. RESULTS Size, longitudinal location, shape, contour, growth pattern, SI on T1- and T2WI, enhancement pattern, hemorrhage, necrosis, ADC, and SUVmax were significantly different among non-GISTs, low-risk GISTs, and high-risk GISTs (p < 0.05). On multivariate analysis, SI on T2WI (hazard ratio [HR], 66.0; p = 0.002) was the only independent variable for differentiating GISTs from non-GISTs whereas enhancement pattern (HR, 56.0; p = 0.041), ADC (HR, 0.997; p = 0.01), and SUVmax (HR, 2.08; p = 0.027) were significant features for differentiating between high-risk and low-risk GISTs. CONCLUSIONS Several qualitative and quantitative MRI and PET features including ADC and SUVmax values are significantly different among non-GISTs, low-risk GISTs, and high-risk GISTs. Multiparametric information obtained from MRI with or without PET can be useful for differentiation of gastric subepithelial tumors as well as for determining patients' management and prognosis. KEY POINTS • Several qualitative MRI features are helpful in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs as well as high-risk GISTs from low-risk GISTs. • Apparent diffusion coefficient value on diffusion-weighted imaging can be useful in distinguishing GISTs from non-GISTs as well as high-risk GISTs from low-risk GISTs. • PET has the potential to distinguish between high-risk and low-risk GISTs.
Collapse
Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| |
Collapse
|
16
|
Yin YQ, Liu CJ, Zhang B, Wen Y, Yin Y. Association between CT imaging features and KIT mutations in small intestinal gastrointestinal stromal tumors. Sci Rep 2019; 9:7257. [PMID: 31076599 PMCID: PMC6510782 DOI: 10.1038/s41598-019-43659-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/27/2019] [Indexed: 02/05/2023] Open
Abstract
Small intestinal gastrointestinal stromal tumors (GISTs) have different clinical outcomes when KIT mutations are in exons 11 or 9, which are also the most common sites of neoplastic KIT mutations. The purpose of this study is to evaluate the CT imaging features in those two groups. A total of 35 patients were enrolled, and both quantitative and qualitative CT imaging features were compared between patient groups with KIT exon 9 mutations (KIT–9) and exon 11 mutations (KIT–11). The KIT–9 group was statistically associated with a tumor size larger than 10 cm and a higher enhancement ratio when compared with those of the KIT–11 group (both P < 0.05). For the enhancement ratio, the receiver operating characteristic curve indicated a cut-off value of 1.60 to differentiate KIT–9 from KIT–11 tumors. Additionally, tumor necrosis was more commonly seen in the KIT-9 group. In multivariate analysis, tumor size (β = 0.206; P = 0.022) and KIT–9 (β = 0.389; P = 0.006) were independent factors associated with tumor necrosis. Taken together, KIT–9 mutant tumors tended to have CT imaging features indicative of more aggressive neoplasms. These findings may be helpful in identifying more aggressive small intestinal GISTs and optimizing treatment.
Collapse
Affiliation(s)
- Yi-Qiong Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Chun-Juan Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yue Wen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| |
Collapse
|
17
|
Chen T, Xu L, Dong X, Li Y, Yu J, Xiong W, Li G. The roles of CT and EUS in the preoperative evaluation of gastric gastrointestinal stromal tumors larger than 2 cm. Eur Radiol 2019; 29:2481-2489. [PMID: 30617491 DOI: 10.1007/s00330-018-5945-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/11/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the endoscopic ultrasound (EUS) and computed tomography (CT) features of gastric gastrointestinal stromal tumors (GISTs) for assessing potential malignancy and prognosis. METHODS Fifty consecutive patients with primary gastric GISTs larger than 2 cm were retrospectively enrolled in this study. The association of CT and EUS features with malignancy was analyzed using univariate and stepwise logistic regression method. The agreement between EUS/CT lesion size and pathologic tumor size was analyzed by calculating the intraclass correlation coefficient (ICC) value, and the association of imaging features with mitotic counts was further analyzed using univariate analysis. The Kaplan-Meier method and Cox proportional hazards models were used to assess the value of imaging features for predicting the prognosis of GIST patients. RESULTS Tumor size > 5 cm and an exophytic/mixed growth pattern on CT as well as tumor size > 5 cm and the presence of cystic spaces on EUS were independent predictors of highly malignant GISTs (all p < 0.05). The ICC values of CT/EUS lesion size relative to pathologic tumor size showed very good reliability (0.853 for EUS and 0.831 for CT). Only tumor shape and growth pattern on CT were significant for predicting mitotic index (both p < 0.05). Direct organ invasion on CT (p = 0.036; hazard ratio [HR] = 11.891) and serosal invasion on EUS (p = 0.015; HR = 8.223) were independent adverse prognostic factors. CONCLUSIONS CT features may be more useful than EUS features for predicting tumor mitotic index. In addition, preoperative imaging features can help predict the prognosis of gastric GISTs. KEY POINTS • Both CT and EUS features can be used for risk stratification of gastric GISTs larger than 2 cm. • CT features performed better than EUS features for predicting tumor mitotic index. • Preoperative imaging features can help predict the prognosis of gastric GISTs.
Collapse
Affiliation(s)
- Tao Chen
- Department of General Surgery, Nanfang Hospital, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
| | - Lili Xu
- Medical Image Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Xiaoyu Dong
- Department of General Surgery, Nanfang Hospital, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Yue Li
- Department of Digestive Endoscopy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Wei Xiong
- Department of General Surgery, Nanfang Hospital, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China. .,Medical Image Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| |
Collapse
|
18
|
Feng C, Lu F, Shen Y, Li A, Yu H, Tang H, Li Z, Hu D. Tumor heterogeneity in gastrointestinal stromal tumors of the small bowel: volumetric CT texture analysis as a potential biomarker for risk stratification. Cancer Imaging 2018; 18:46. [PMID: 30518436 PMCID: PMC6280355 DOI: 10.1186/s40644-018-0182-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background To explore whether volumetric CT texture analysis (CTTA) can serve as a potential imaging biomarker for risk stratification of small bowel gastrointestinal stromal tumors (small bowel-GISTs). Methods A total of 90 patients with small bowel-GISTs were retrospectively reviewed, of these, 26 were rated as high risk, 13 as intermediate risk, and 51 as low or very low risk. Histogram parameters extracted from CT images were compared among small bowel-GISTs with different risk levels by using one-way analysis of variance. Receiver operating characteristics (ROCs) and areas under the curve (AUCs) were analyzed to determine optimal histogram parameters for stratifying tumor risk. Results Significant differences in mean attenuation, 10th, 25th, 50th, 75th and 90th percentile attenuation, and entropy were found among high, intermediate, and low risk small bowel-GISTs (p ≤ 0.001). Mean attenuation, 10th, 25th, 50th, 75th and 90th percentile attenuation, and entropy derived from arterial phase and venous phase images correlated significantly with risk levels (r = 0.403–0.594, r = 0.386–0.593, respectively). Entropy in venous phase reached the highest accuracy (AUC = 0.830, p < 0.001) for differentiating low risk from intermediate to high risk small bowel-GISTs, with a cut-off value of 5.98, and the corresponding sensitivity and specificity were 82.4 and 74.4%, respectively. Conclusions Volumetric CT texture features, especially entropy, may potentially serve as biomarkers for risk stratification of small bowel-GISTs.
Collapse
Affiliation(s)
- Cui Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Fangfang Lu
- Department of Radiology, Luoyang Central Hospital, Zhengzhou University, Luoyang, 471009, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Hao Yu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Hao Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China.
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| |
Collapse
|
19
|
Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Peña S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceño-Delgado J. Gastrointestinal stromal tumors: A multidisciplinary challenge. World J Gastroenterol 2018; 24:1925-1941. [PMID: 29760538 PMCID: PMC5949708 DOI: 10.3748/wjg.v24.i18.1925] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.
Collapse
Affiliation(s)
- Juan Manuel Sanchez-Hidalgo
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Manuel Duran-Martinez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Rafael Molero-Payan
- Department of Intern Medicine, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
- Lipids and Atherosclerosis Research Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Cordoba 14004, Spain
| | - Sebastian Rufian-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Alvaro Arjona-Sanchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Angela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Antonio Cosano-Alvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| |
Collapse
|
20
|
Nishida T, Cho H, Hirota S, Masuzawa T, Chiguchi G, Tsujinaka T. Clinicopathological Features and Prognosis of Primary GISTs with Tumor Rupture in the Real World. Ann Surg Oncol 2018; 25:1961-1969. [PMID: 29752602 PMCID: PMC5976711 DOI: 10.1245/s10434-018-6505-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/21/2023]
Abstract
Background Patients with ruptured gastrointestinal stromal tumor (GIST) are recommended for imatinib adjuvant therapy; however, their clinicopathological features and prognosis in the era of imatinib are unknown. Patients and Methods The study cohort included 665 patients with histologically proven primary GISTs who underwent R0 or R1 surgery between 2003 and 2007; the validation cohort included 182 patients between 2000 and 2014. The definitions of tumor rupture in the study included perforation at tumor site, tumor fracture, piecemeal resection including open biopsy, and macroscopic injuries to the pseudocapsule. Results Tumor rupture occurred in 21 (3.2%) of 665 and 5 (2.9%) of 182 patients in the study and validation cohort, respectively. Ruptured GISTs were more symptomatic, were larger in size, and had higher mitotic count than nonruptured GISTs but were not associated with tumor location or laparoscopic surgery. GISTs with intraoperative rupture had clinicopathological features and prognostic outcomes similar to those with preoperative rupture. Recurrence rates were higher and median recurrence-free survival (RFS) and overall survival (OS) were shorter with ruptured than nonruptured GIST. Tumor rupture was one of the independent prognostic factors for RFS, but not OS, according to multivariate analysis. Conclusions Ruptured GISTs were symptomatic larger tumors with high mitotic activity, frequent relapse, and shorter RFS. Tumor rupture was an independent prognostic factor for RFS, but not for OS, in the era of imatinib. Electronic supplementary material The online version of this article (10.1245/s10434-018-6505-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Toshirou Nishida
- Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. .,Department of Surgery, Osaka Police Hospital, Osaka, Japan. .,Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan.
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toru Masuzawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan.,Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Gaku Chiguchi
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Toshimasa Tsujinaka
- Department of Gastrointestinal Surgery, Kaizuka City Hospital, Kaizuka, Japan
| | | |
Collapse
|