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. 2009 Jul 21;15(27):3376-81.
doi: 10.3748/wjg.15.3376.

Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?

Gwang Ha Kim  1 , Do Youn Park, Suk Kim, Dae Hwan Kim, Dong Heon Kim, Cheol Woong Choi, Jeong Heo, Geun Am Song
Affiliations

Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?

Gwang Ha Kim et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the ultrasonography (EUS) features of gastric gastrointestinal stromal tumors (GISTs) as compared with gastric leiomyomas and then to determine the EUS features that could predict malignant GISTs.

Methods: We evaluated the endoscopic EUS features in 53 patients with gastric mesenchymal tumors confirmed by histopathologic diagnosis. The GISTs were classified into benign and malignant groups according to the histological risk classification.

Results: Immunohistochemical analyses demonstrated 7 leiomyomas and 46 GISTs. Inhomogenicity, hyperechogenic spots, a marginal halo and higher echogenicity as compared with the surrounding muscle layer appeared more frequently in the GISTs than in the leiomyomas (P < 0.05). The presence of at least two of these four features had a sensitivity of 89.1% and a specificity of 85.7% for predicting GISTs. Except for tumor size and irregularity of the border, most of the EUS features were not helpful for predicting the malignant potential of GISTs. On multivariate analysis, only the maximal diameter of the GISTs was an independent predictor. The optimal size for predicting malignant GISTs was 35 mm. The sensitivity and specificity using this value were 92.3% and 78.8%, respectively.

Conclusion: EUS may help to differentiate gastric GISTs from gastric leiomyomas. Once GISTs are suspected, surgery should be considered if the size is greater than 3.5 cm.

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Figures

Figure 1
Figure 1
EUS features of gastric mesenchymal tumors. A: A gastric leiomyoma. The mass is homogenous and its echogenicity is similar to that of the surrounding normal muscle layer. It is 35 mm × 13 mm in size and a marginal halo is not observed; B: A gastric GIST with low risk potential. The mass is inhomogenous and its echogenicity is somewhat higher than that of the surrounding muscle layer. It is 25 mm × 18 mm in size. A marginal halo (arrow) and hyperechogenic spots are seen; C: A gastric GIST with high risk potential. The mass is inhomogenous and 82 mm × 76 mm in size. A marginal halo, hyperechogenic spots and irregular border (arrow head) are seen.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve of the tumor size for predicting malignant GISTs in the stomach.
See this image and copyright information in PMC

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