Differentiation of large (≥5cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists’ performance using CT

Choi, Ye Ra; Kim, Se Hyung; Kim, Sunah; Shin, Cheong Il; Kim, Hyung Jin; Kim, Seong Ho; Han, Joon Koo; Choi, Byung Ihn

doi:10.1016/j.ejrad.2013.10.028

Cited by 58 publications

(91 citation statements)

References 23 publications

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“…To address this issue, previous investigations have identified that certain CT features, including the density, enhancement pattern, growth pattern and the presence of PLNs, as well as doubling times, may assist in differentiating gastric schwannoma from GIST (13,14). However, the majority of previous studies have focused on certain qualitative CT features that are highly dependent on the experience of the attending radiologists (13,14). Additionally, numerous previous studies had small gastrointestinal schwannoma sample sizes.…”

Section: Introductionmentioning

confidence: 87%

“…Choi et al (13) interpreted that exophytic or mixed growth and slower doubling time patterns were the most common types of CT feature associated with gastric schwannomas diagnoses. Choi et al (14) demonstrated that the pattern of enhancement, the size of the tumor, and the presence of necrosis and enlarged lymph nodes were significantly different between GISTs and schwannomas. The qualitative analysis data of the present study are consistent with these data.…”

Section: Schwannomas (N=15) Gists (N=50) ----------------------------mentioning

confidence: 99%

“…Choi et al (13) and Choi et al (14) attempted to identify the CT features that may assist in distinguishing small (<5 cm) and large (≥5 cm) gastric GISTs from schwannomas. These studies revealed that certain CT features, including a homogenous enhancement pattern and PLNs, were more likely to indicate gastric schwannomas than GISTs.…”

Section: Schwannomas (N=15) Gists (N=50) ----------------------------mentioning

confidence: 99%

“…However, differentiating between GISTs and gastrointestinal schwannomas prior to surgery remains challenging due to their similar CT appearances, and schwannomas are commonly misdiagnosed as GISTs (6,12). To address this issue, previous investigations have identified that certain CT features, including the density, enhancement pattern, growth pattern and the presence of PLNs, as well as doubling times, may assist in differentiating gastric schwannoma from GIST (13,14). However, the majority of previous studies have focused on certain qualitative CT features that are highly dependent on the experience of the attending radiologists (13,14).…”

Section: Introductionmentioning

confidence: 99%

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Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Zhang²,

Peng

et al. 2017

Oncology Letters

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Abstract. The aim of the present study was to identify computed tomography (CT) features to assist in differentiating gastrointestinal schwannomas from gastrointestinal stromal tumors (GISTs). CT images of gastrointestinal schwannomas (n=15) and GISTs (n=50) were analyzed. The absolute CT values of tumor/aorta during plain scan/arterial phase/venous phase were recorded as tumor plain scan (Tp)/aorta plain scan (Ap), tumor arterial phase (Ta)/aorta arterial phase (Aa) and tumor venous phase (Tv)/aorta venous phase (Av), respectively, and normalized CT values of the three phases were calculated as Sp=Tp/Ap, Sa=Ta/Aa and Sv=Tv/Av, respectively. The difference in tumor CT value between arterial and venous phases was calculated and recorded as Tv-a. CT data including tumor size, contour, margin, growth pattern, presence of calcification, cystic change, hemorrhage, ulceration, perilesional lymph nodes (PLNs), local invasion to surrounding structures, metastasis, ascites, vasculatures, enhancement pattern/degree, Tp/Ta/Tv and Sp/Sa/Sv were evaluated for each patient. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the CT data to differentiate gastrointestinal schwannomas from GISTs. Compared with GISTs, gastrointestinal schwannomas more frequently demonstrated round contouring, relatively smaller tumor size, a homogeneous enhancement pattern, with the presence of PLNs and a higher level of vasculature (P<0.05), whilst the presence of cystic changes were more common in GISTs compared with gastrointestinal schwannomas (P<0.05). The Sa, Ta and Tv-a of gastrointestinal schwannomas were less compared with those of GISTs (P<0.05). The difference in margin, growth pattern, intra-tumoral calcifications and hemorrhage were insignificant (P>0.05). ROC analysis indicated that tumor size, cystic change, the presence of PLNs, tumor enhancement pattern and Sa demonstrated improved diagnostic potential compared with others [area under the curve (AUC) >0.7], amongst which cystic change demonstrated the best diagnostic ability (AUC=0.82). Size exhibited the highest sensitivity, 90%, and cystic change, Sa exhibited the best specificity, 87%. Quantitative analysis indicated that certain features aided the differentiation between gastrointestinal schwannomas and GISTs using CT imaging. IntroductionSchwannoma are benign tumors arising from Schwann cells in the sheaths of peripheral nerves. Schwannoma are homogeneous tumors and may occur in any tissue of the body. The head and neck region is the most prevalent location for schwannoma to occur; they are rarely observed in the gastrointestinal tract (1). Conventional schwannoma usually arise from peripheral skin nerves and connective tissue, whereas gastrointestinal schwannoma tumors are derived from Schwann cells of the Auerbach's plexus within the gastrointestinal tract wall (1-3) and were first reported by Daimaru et al in 1988 (1)

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Section: Introductionmentioning

confidence: 87%

Section: Schwannomas (N=15) Gists (N=50) ----------------------------mentioning

confidence: 99%

Section: Schwannomas (N=15) Gists (N=50) ----------------------------mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Zhang²,

Peng

et al. 2017

Oncology Letters

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show abstract

“…Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are both used to evaluate the extent of the primary tumor as well as its relation to adjacent organs and to detect gross metastatic disease. Moreover, CT and MRI imaging criteria have been described to help differentiate GISTs from other gastrointestinal tumors [24,25] and to estimate their malignant potential [26,27], although these need to be validated in larger trials.…”

Section: Diagnosismentioning

confidence: 99%

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Garlipp

Bruns

2014

Gastrointest Tumors

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Background: Gastrointestinal stromal tumors (GISTs) are the most frequently diagnosed mesenchymal neoplasms of the gastrointestinal tract. Despite their biological and clinical heterogeneity, the majority of these tumors are positive for the receptor tyrosine kinase KIT and are driven by KIT- or platelet-derived growth factor receptor alpha (PDGFRA)-activating mutations. There are still uncertainties regarding their clinical and molecular characterization and the optimal treatment regimens, making it difficult to establish a universal treatment algorithm for these tumors. Summary: From a clinical perspective, the main difference between GISTs and other gastrointestinal neoplasms is that the benign or malignant behavior of GISTs cannot be predicted from histopathology, but instead relies on empirically established scoring systems. Clinical data suggest that malignant potential may be an inherent quality of some GISTs rather than a feature acquired by the tumor during disease progression. Thus, some patients may require prolonged anti-tumor treatment even after complete surgical removal of the tumor. Key Message: Although GISTs are the most frequently occurring mesenchymal neoplasms in the gastrointestinal tract, no universal treatment algorithms exist. This paper reviews the current evidence that guides the management of GISTs. Practical Implications: The management of localized GISTs involves the use of surgical resection, with the inclusion of preoperative tyrosine kinase inhibitor treatment for locally advanced, primarily unresectable tumors and for resectable cases requiring extensive surgery. Imatinib is also indicated as adjuvant therapy after complete surgical removal of GISTs with a high estimated risk of recurrence unless specific mutations conferring imatinib resistance are present. The optimal duration of adjuvant treatment is still controversial. For patients with metastatic imatinib-sensitive GISTs, imatinib constitutes the first-line standard treatment. Molecular characterization of the tumor (with respect to the PDGFRA and KIT genes) is mandatory prior to imatinib therapy. Sunitinib and regorafenib are established as alternative treatments for patients demonstrating generalized disease progression on imatinib. New tyrosine kinase inhibitors such as ponatinib and crenolanib as well as drugs targeting alternative pathways are currently under investigation. Surgery and locally ablative treatments may be indicated in some metastatic patients.

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Randomized crossover trial comparing EUS‐guided fine‐needle aspiration with EUS‐guided fine‐needle biopsy for gastric subepithelial tumors

Iwai

Kida

Inoue

et al. 2017

Diagnostic Cytopathology

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Differentiation of large (≥5cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists’ performance using CT

Cited by 58 publications

References 23 publications

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

Differentiation between gastrointestinal schwannomas and gastrointestinal stromal tumors by computed tomography

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Randomized crossover trial comparing EUS‐guided fine‐needle aspiration with EUS‐guided fine‐needle biopsy for gastric subepithelial tumors

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