Tao Chen1, Lili Xu2, Xiaoyu Dong3, Yue Li4, Jiang Yu3, Wei Xiong5,6, Guoxin Li3. 1. 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. drchentao@163.com. 2. Medical Image Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China. 3. 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. 4. Department of Digestive Endoscopy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China. 5. 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. nick717@126.com. 6. Medical Image Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China. nick717@126.com.
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.
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 GISTpatients. 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.
Authors: A C O'Neill; A B Shinagare; V Kurra; S H Tirumani; J P Jagannathan; A D Baheti; J L Hornick; S George; N H Ramaiya Journal: Eur J Surg Oncol Date: 2016-04-21 Impact factor: 4.424