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. 2020 Aug;36(4):318-324.
doi: 10.1159/000504327. Epub 2019 Nov 19.

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

Rolandas Vaicekauskas  1 , Jurgita Urbonienė  2 , Juozas Stanaitis  1 , Jonas Valantinas  1
Affiliations

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

Rolandas Vaicekauskas et al. Visc Med. 2020 Aug.

Abstract

Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy.

Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT.

Materials and methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features.

Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs.

Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.

Keywords: Endoscopic ultrasound; Gastrointestinal stromal tumor; Leiomyoma; Upper endoscopy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Upper endoscopic image of a stomach gastrointestinal stromal tumor.
Fig. 2
Fig. 2
Upper endoscopic image of a stomach leiomyoma.
Fig. 3
Fig. 3
Endoscopic ultrasound image of a stomach gastrointestinal stromal tumor.
Fig. 4
Fig. 4
Endoscopic ultrasound image of a stomach leiomyoma.
Fig. 5
Fig. 5
Receiver operating characteristic curves of tumor location and endoscopic ultrasound features for predicting gastrointestinal stromal tumors.
See this image and copyright information in PMC

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