Contrast‐enhanced endoscopic ultrasonography can predict a higher malignant potential of gastrointestinal stromal tumors by visualizing large newly formed vessels

Yamashita, Yasunobu; Kato, Jun; Ueda, Kazuki; Nakamura, Yasushi; Abe, Hiroko; Tamura, Takashi; Itonaga, Masahiro; Yoshida, Takeichi; Maeda, Hiroki; Moribata, Kosaku; Niwa, Toshimitsu; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Ichinose, Masakazu

doi:10.1002/jcu.22195

Cited by 39 publications

(48 citation statements)

References 36 publications

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“…GIST was initially a purely descriptive term coined in 1983 by Mazur and Clark to define intra-abdominal tumors that were definitely not carcinomas [2, 3]. GISTs account for about 80% of gastrointestinal sarcomas, with a mean annual incidence of 10-15 per million [4, 5]. Nearly 50-70% of the clinically apparent tumors arise in the stomach, 20-30% arise in the small intestine, 5-15% in the large intestine, and less than 5% in other locations [6].…”

Section: Introductionmentioning

confidence: 99%

Beyond standard therapy: drugs under investigation for the treatment of gastrointestinal stromal tumor

Alturkmani

Pessetto

Godwin

2015

Expert Opinion on Investigational Drugs

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Introduction Gastrointestinal stromal tumor (GIST) is the most common non-epithelial malignancy of the GI tract. With the discovery of KIT and later PDGFRA gain-of-function mutations as factors in the pathogenesis of the disease, GIST was the quintessential model for targeted therapy. Despite the successful clinical use of imatinib mesylate, a selective receptor tyrosine kinase (RTK) inhibitor that targets KIT, PDGFRA and BCR-ABL, we still do not have treatment for the long-term control of advanced GIST. Areas covered This review summarizes the drugs that are under investigation or have been assessed in trials for GIST treatment. The article focuses on their mechanisms of actions, the preclinical evidence of efficacy, and the clinical trials concerning safety and efficacy in humans. Expert opinion It is known that KIT and PDGFRA mutations in GIST patients influence the response to treatment. This observation should be taken into consideration when investigating new drugs. RECIST was developed to help uniformly report efficacy trials in oncology. Despite the usefulness of this system, many questions are being addressed about its validity in evaluating the true efficacy of drugs knowing that new targeted therapies do not affect the tumor size as much as they halt progression and prolong survival.

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Section: Introductionmentioning

confidence: 99%

Beyond standard therapy: drugs under investigation for the treatment of gastrointestinal stromal tumor

Alturkmani

Pessetto

Godwin

2015

Expert Opinion on Investigational Drugs

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“…CEUS and CH-EUS have been evaluated in three series that sought to determine the malignancy potential of GISTs. [111216]…”

Section: Assessment Of the Malignant Potential Of The Gastrointestinamentioning

confidence: 99%

“…In the series of Yamashita et al ., 13 patients with GISTs underwent presurgical CH-EUS. [12] The analysis of the intratumoral vessels on the CH-EUS was compared with the histological degrees of angiogenesis and the VEGF expressions of the surgical specimens. On pathological examination, all of the intermediate high-risk GISTs expressed high levels of VEGF whereas all of the low-risk GISTs were VEGF-negative.…”

Section: Assessment Of the Malignant Potential Of The Gastrointestinamentioning

confidence: 99%

Role of contrast-enhanced harmonic endoscopic ultrasound in submucosal tumors

et al. 2016

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With the widespread use of endoscopy, gastrointestinal submucosal lesions are now more commonly discovered. Although endoscopic ultrasound (EUS) is superior to all other imaging techniques for the diagnosis of submucosal tumors (SMTs), it is still suboptimal for differentiating hypoechoic lesions arising from the fourth sonographic gastrointestinal wall layer, which encompass tumors with very different prognosis. EUS tissue acquisition has provided with the unique opportunity to obtain histological confirmation, but it is not accurate enough to evaluate the malignant potential of gastrointestinal stromal tumors (GISTs). In the last years, contrast-enhanced harmonic EUS (CH-EUS) emerged as a powerful imaging modality to assess the microperfusion patterns of pancreatic tumors. Based on the distinct microvascularity of malignant SMTs, it was hypothesized that CH-EUS might also assist in the differential diagnosis of SMTs. Preliminary experience in this field is now available and suggests CH-EUS as a performant modality to distinguish between benign SMTs and GISTs and to evaluate the malignant potential of GISTs. High expectations are also relied on CH-EUS for the monitoring of antiangiogenic treatments of GISTs and the evaluation of gastrointestinal neuroendocrine tumors (NETs).

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“…[61516] Recent studies have shown that this novel technique can differentiate subepithelial lesions on the basis of the pattern of contrast enhancement or by detecting intratumoral vessels, but whether or not CEH-EUS can predict the malignancy risk of GISTs remains unclear. [68121417] The aim of our study was to evaluate whether CEH-EUS findings can identify SETs and predict the malignancy risk of GISTs, in comparison with surgical pathologic findings.…”

Section: Introductionmentioning

confidence: 99%

Can contrast-enhanced harmonic endosonography predict malignancy risk in gastrointestinal subepithelial tumors?

et al. 2016

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Background and Objectives:Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) is a novel technology that can identify subepithelial tumors (SETs) by detecting the degree of enhancement, but whether CEH-EUS can predict the malignancy risk of gastrointestinal stromal tumors (GISTs) remains unclear. The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS and its ability to discriminate among SETs and predict the malignancy risk of GISTs.Materials and Methods:We retrospectively included patients with suspected subepithelial lesions who underwent CEH-EUS preoperatively. Thirty-five patients with histologically proven GISTs and benign neoplasms were enrolled in the study. The images of CEH-EUS were categorized in accordance with microvasculature, parenchymal perfusion, and nonenhancing spots. The diagnostic performance of CEH-EUS was evaluated by comparing these findings with the histological diagnosis.Results:When we divided the enrolled patients into high- and low-grade malignancy and benign groups, nonenhancing spots on CEH-EUS were found more frequently in the high-grade malignancy group (63.6%), followed by the low-grade malignancy (46.7%) and benign groups (25.7%) (P = 0.022). However, based on the statistical validity of the CEH-EUS findings for the discrimination of SETs, the sensitivity was 53.8% for diagnostic performance and 63.6% for prediction of malignancy risk of GISTs.Conclusions:From our study results, it is unclear whether CEH-EUS alone has a diagnostic role in the discrimination of SETs and the prediction of malignancy risk of GISTs. Further studies with larger samples from multiple centers and use of other imaging analysis modalities are needed.

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Contrast‐enhanced endoscopic ultrasonography can predict a higher malignant potential of gastrointestinal stromal tumors by visualizing large newly formed vessels

Abstract: Intratumoral vessels observed in GISTs on CE-EUS are correlated with a higher degree of angiogenesis, resulting in higher malignant potential.

Cited by 39 publications

References 36 publications

Beyond standard therapy: drugs under investigation for the treatment of gastrointestinal stromal tumor

Beyond standard therapy: drugs under investigation for the treatment of gastrointestinal stromal tumor

Role of contrast-enhanced harmonic endoscopic ultrasound in submucosal tumors

Can contrast-enhanced harmonic endosonography predict malignancy risk in gastrointestinal subepithelial tumors?

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