Retrospective Study
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World J Gastrointest Oncol. Oct 15, 2022; 14(10): 2004-2013
Published online Oct 15, 2022. doi: 10.4251/wjgo.v14.i10.2004
Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment
Xiao-Long Li, Peng-Fei Han, Wei Wang, Li-Wei Shao, Ying-Wei Wang
Xiao-Long Li, Peng-Fei Han, Wei Wang, Ying-Wei Wang, Diagnostic Radiology Department, The First Medical Center of PLA General Hospital, Beijing 100853, China
Li-Wei Shao, Pathology Department, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
Author contributions: Li XL and Han PF contributed equally to this article and should be considered as co-first authors; Li XL, Han PF and Wang YW wrote the paper; Li XL, Han PF and Shao LW were responsible for sorting the data.
Institutional review board statement: The study was reviewed and approved by the First Medical Center of PLA General Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report no conflict of interest.
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: Ying-Wei Wang, PhD, Attending Doctor, Diagnostic Radiology Department, The first medical center of PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. wangyw301@163.com
Received: June 22, 2022
Peer-review started: June 22, 2022
First decision: July 12, 2022
Revised: July 18, 2022
Accepted: September 13, 2022
Article in press: September 13, 2022
Published online: October 15, 2022
Abstract
BACKGROUND

The biological characteristics of gastric stromal tumors are complex, and their incidence has increased in recent years. Gastric stromal tumors (GST) have potential malignant tendencies, and the probability of transformation into malignant tumors is as high as 20%-30%.

AIM

To investigate the value of multi-slice spiral computed tomography (MSCT) in the differential diagnosis of GST and benign gastric polyps, and GST risk stratification assessment.

METHODS

We included 64 patients with GST (GST group) and 60 with benign gastric polyps (control group), confirmed by pathological examination after surgery in PLA General Hospital, from January 2016 to June 2021. The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared. According to the National Institutes of Health’s standard, GST is divided into low- and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values.

RESULTS

The incidences of extraluminal growth, blurred boundaries, and ulceration in the GST group were significantly higher than those in the control group (P < 0.05). The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group (P < 0.05). The MSCT differential diagnosis of GST and gastric polyp sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and areas under the curve (AUCs) were 73.44 %, 83.33%, 26.56%, 16.67%, 0.784, respectively. The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value, with a statistical difference. The results showed that the sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%, 62.20%, 19.82%, 37.80%, and 0.710, respectively. The sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%, 60.40%, 32.37%, 39.60%, and 0.710, respectively. The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group (P < 0.05). The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group (P < 0.05).

CONCLUSION

Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.

Keywords: Multi-slice spiral computed tomography, Differential diagnosis, Gastric stromal tumor, Benign gastric polyps, Risk stratification

Core Tip: Gastric stromal tumors (GSTs) are common gastrointestinal tumors and have a certain possibility of malignant change. Therefore, surgical intervention is important. However, the signs of early patients are not obvious, and difficult to distinguish from benign gastric tumors. Imaging examinations have always been the main methods for diagnosing GSTs. The degree of risk to patients can be evaluated by performing a computed tomography (CT) examination. In this study, a CT examination was performed to analyze the difference in CT performance between GSTs and gastric polyps, to provide the corresponding basis for early diagnosis of GSTs and reasonable selection of treatment methods.