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European Radiology
Published in: European Radiology 5/2019

01-05-2019 | Computed Tomography | Gastrointestinal

The roles of CT and EUS in the preoperative evaluation of gastric gastrointestinal stromal tumors larger than 2 cm

Authors: Tao Chen, Lili Xu, Xiaoyu Dong, Yue Li, Jiang Yu, Wei Xiong, Guoxin Li

Published in: European Radiology | Issue 5/2019

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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.
Appendix
Available only for authorised users
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Metadata
Title
The roles of CT and EUS in the preoperative evaluation of gastric gastrointestinal stromal tumors larger than 2 cm
Authors
Tao Chen
Lili Xu
Xiaoyu Dong
Yue Li
Jiang Yu
Wei Xiong
Guoxin Li
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5945-6

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