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

ObjectiveThis 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.MethodsFifty consecutive patients with primary gastric GISTs larger than 2cm 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.ResultsTumor size >5cm and an exophytic/mixed growth pattern on CT as well as tumor size >5cm 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.ConclusionsCT 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 center dot Both CT and EUS features can be used for risk stratification of gastric GISTs larger than 2cm.center dot CT features performed better than EUS features for predicting tumor mitotic index.center dot Preoperative imaging features can help predict the prognosis of gastric GISTs.