Internal hypoechoic feature by EUS as a possible predictive marker for the enlargement potential of gastric GI stromal tumors

• Published in: Gastrointestinal endoscopy 2012-04, Vol.75 (4), p.731-738
• Main Authors: Onishi, Miho, MD, Tominaga, Kazunari, MD, PhD, Sugimori, Satoshi, MD, PhD, Machida, Hirohisa, MD, Okazaki, Hirotoshi, MD, Yamagami, Hirokazu, MD, PhD, Tanigawa, Tetsuya, MD, PhD, Watanabe, Kenji, MD, PhD, Watanabe, Toshio, MD, PhD, Fujiwara, Yasuhiro, MD, PhD, Arakawa, Tetsuo, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Confidence Intervals; Digestive system. Abdomen; Disease Progression; Endoscopy; Endosonography; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Stromal Tumors - diagnostic imaging; Gastrointestinal Stromal Tumors - pathology; Gastroscopy; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Retrospective Studies; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumor Burden; Tumors
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.10.036

Background There is no clinical predictor for the enlargement potential of gastric GI stromal tumors (GISTs) during the follow-up observation period. Objective The aim of our study was to identify predictive markers for the enlargement potential of gastric GISTs on the basis of various endosonographic features determined at the initial examination. Design Single-center retrospective analysis. Setting Academic university hospital in Japan. Patients All patients (n = 74) with histologically diagnosed GISTs in the stomach underwent EUS. Intervention EUS. Main Outcome Measurements We analyzed the following endoscopic and EUS features: mucosal ulceration, irregular shape, irregular border, heterogeneity, internal hyperechoic spot, hypoechoic area, and anechoic area of gastric GISTs in 3 groups according to tumor size. Furthermore, we compared the characteristics between increased growth and unchanged growth of GISTs, that were defined on the basis of the novel tumor growth index: changes in tumor volume/follow-up interval (days between initial EUS and second EUS) (mm3 /day). Results The presence of heterogeneity ( P = .016) and anechoic area ( P = .003) was significantly highest in the group with the largest tumor size. The increased growth group had a higher presence of hypoechoic area than did the unchanged growth group (84.2% vs 51.9%, P = .023). Multivariate analysis showed that the presence of a hypoechoic area was an enlargement-associated factor (odds ratio 5.38; 95% confidence interval 1.19-24.39; P = .029). Limitations Retrospective design of the study. Conclusions The internal hypoechoic area determined by EUS may be a predictor for the enlargement potential of gastric GISTs.