Published online Oct 7, 2022. doi: 10.3748/wjg.v28.i37.5457
Peer-review started: June 22, 2022
First decision: September 2, 2022
Revised: September 14, 2022
Accepted: September 20, 2022
Article in press: September 20, 2022
Published online: October 7, 2022
Small gastrointestinal stromal tumors (GISTs) have a high incidence, and their prognosis and treatment remain controversial.
Endoscopic ultrasound (EUS) plays a pivotal role in the diagnosis of GISTs, but its ability to assess the prognosis of small GISTs remains to be explored.
To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.
We collected data from patients with small GISTs, the diagnosis and risk classifications of which were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery. The assessment results based on EUS features (marginal irregularity, cystic changes, homogeneity, ulceration, and strong echogenic foci) were compared with the pathological features.
A total of 256 patients (69 men and 187 women) were enrolled. Tumor size was positively correlated with the mitotic index (P < 0.001). Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential (95% confidence interval: 0.824–0.956). EUS heterogeneity with tumor diameters > 1.48 cm was associated with higher risk classification (P < 0.05).
Small GISTs (diameters, > 1.48 cm) with positive EUS features should receive intensive surveillance or undergo endoscopic surgery. EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.
EUS provides reference evidence for the precise assessment and early risk assessment of small GISTs.