Original Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 21, 2009; 15(27): 3376-3381
Published online Jul 21, 2009. doi: 10.3748/wjg.15.3376
Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?
Gwang Ha Kim, Do Youn Park, Suk Kim, Dae Hwan Kim, Dong Heon Kim, Cheol Woong Choi, Jeong Heo, Geun Am Song
Gwang Ha Kim, Cheol Woong Choi, Jeong Heo, Geun Am Song, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea
Do Youn Park, Department of Pathology, Pusan National University School of Medicine, Busan 602-739, South Korea
Suk Kim, Department of Radiology, Pusan National University School of Medicine, Busan 602-739, South Korea
Dae Hwan Kim, Dong Heon Kim, Department of Surgery, Pusan National University School of Medicine, Busan 602-739, South Korea
Author contributions: Kim GH, Park DY and Song GA designed the research; Kim S, Kim DH, Choi CW and Heo J performed the research; Kim GH and Kim DH analyzed the data; Kim GH wrote the paper.
Correspondence to: Geun Am Song, MD, PhD, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, 1-10 Ami-dong, Seo-Gu, Busan 602-739, South Korea. gasong@pusan.ac.kr
Telephone: +82-51-2407869
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Received: April 9, 2009
Revised: June 13, 2009
Accepted: June 20, 2009
Published online: July 21, 2009
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.

Keywords: Endoscopic ultrasonography; Gastrointestinal stromal tumor; Stomach