Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

Abstract

Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.

Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach

“…The round shape and irregular margin of the lesion are also endoscopic ultrasonography features suggestive of GISTs. [ 16 ]…”

“…The round shape and irregular margin of the lesion are also endoscopic ultrasonography features suggestive of GISTs. [16] In the present study, we incorporated CT features of positive contrast enhancement and intra-tumoral necrosis and an endoscopic ultrasonography feature of uneven echogenicity as items for the scoring system, as statistically significant differences were observed in these features between GISTs and non-GISTs. Although it may be possible to increase the accuracy of our scoring system by adding other features characteristic of GISTs, this concept requires further investigation.…”

“…Lesions with at least 2 of these features provided a sensitivity of 89.1% and a specificity of 85.7% for predicting GISTs. The round shape and irregular margin of the lesion are also endoscopic ultrasonography features suggestive of GISTs [16] …”

Artificial Intelligence in the Prediction of Gastrointestinal Stromal Tumors on Endoscopic Ultrasonography Images: Development, Validation and Comparison with Endosonographers

“…In our EUS-AI model, we collected the normal B-mode images, and evaluation of the brightness or grayscale histogram, heterogeneity, shape, "halo" sign, and cystic changes in EUS images may help distinguish SELs. [16][17][18] However, there are other techniques that aid in the differentiation of SELs. A previous study demonstrated the usefulness of elastography in differentiating GISTs and non-GISTs, as the former were found to be harder.…”

Role of Endoscopic Ultrasonography (EUS) in Diagnosis of Subepithelial Lesions (SELS)

“…A study was conducted about EUS reliabity for gastric sub epithelial lesions. Using histopathology as the gold standard, the overall diagnostic accuracy of EUS imaging was 49% (Vaicekauskas et al, 2020).…”