Gastrointestinal stromal tumors: relationship between preoperative CT features and pathologic risk stratification

Abstract

Objective: To investigate a relationship between contrast-enhanced computed tomography (CECT) features of gastrointestinal stromal tumors (GISTs) and risk of relapse according to Miettinen stratified risk classifications. Methods: After ethical committee approval, a retrospective analysis was conducted on the preoperative CECT of patients with pathologically proven GIST undergoing surgery between June 2009 and December 2019. Chi-square analysis was used to evaluate the correlation between Miettinen stratified risk categories and the following imaging features: tumor size and location, growth pattern, margins, type and degree of contrast enhancement, presence of calcifications, necrosis, signs of ulceration/fistulation, internal hemorrhagic foci, enlarged feeding or draining vessels (EFDV), ascites, peritoneal implants, lymphadenopathy, or metastasis. Results: A total of 54 patients (mean age 65 ± 11, 29 men) were included in the study with a total of 56 GISTs. Necrosis, ulceration/fistulation, hemorrhage, margins, enlarged vessels, type of contrast enhancement, and metastasis turned out to be associated with Miettinen risk categories ( p < 0.005). Logistic regression analysis identified the presence of necrosis and EFDV as predictors of pathologic risk of relapse (overall accuracy of 89.3%). Conclusion: Preoperative CECT may be helpful in predicting pathologic risk categories of GISTs, as determined by the Miettinen classification system.

Gastrointestinal neuroendocrine neoplasms (GI-NENs): hot topics in morphological, functional, and prognostic imaging

“…To date, the most widely used imaging modality for the detection of GI-NENs is undoubtedly CECT [4,[22][23][24][25][26], which allows diagnosis, staging, pre-and post-treatment evaluation and follow-up of these neoplasms (Fig. 2).…”

The Utility of Conventional CT, CT Perfusion and Quantitative Diffusion-Weighted Imaging in Predicting the Risk Level of Gastrointestinal Stromal Tumors of the Stomach: A Prospective Comparison of Classical CT Features, CT Perfusion Values, Apparent Diffusion Coefficient and Intravoxel Incoherent Motion-Derived Parameters

“…All classification systems include the size of the tumor lesion as an important predictive factor in the assessment of risk of malignancy [ 7 , 8 , 9 , 10 ]. Many studies have shown the statistical significance of diameter in correlation with the tumor risk grade [ 17 , 18 , 19 , 22 , 23 ]. The cut-off for the size of 5 cm was established with GISTs with diameter less than 5 cm having the best prognosis [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…According to the Choi criteria, partial response to imatinib therapy is demonstrated by 10% decrease of tumor size and 15% decrease in tumor attenuation at follow-up CT [ 21 ]. In addition to the morphological CT features of the tumor that we analyzed, Grazzini et al showed that the intratumoral foci of hemorrhage are also statistically associated with the high AFIP risk categories [ 22 ]. Chen et al found that tumor size bigger than 5 cm, exophytic or mixed growth pattern on CT, and tumor cystic degeneration were independent indicators of higher grade tumors [ 23 , 24 ].…”

Value of 18F-FDG PET/CT for differentiating diagnosis between malignant and benign primary gastric gastrointestinal mesenchymal tumors: a single-center retrospective study

“…EUS can detect submucosal neoplastic lesions well, but it is hard to judge subserosa, deep abdominal lesions and their surrounding conditions. Preoperative contrast-enhanced CT may be helpful in predicting pathologic risk categories of GISTs and multi-parameter MR analysis provides a preoperative imaging standard for accurately distinguishing very low-to-low-risk GIST from intermediate-to-high-risk GIST, which was reported by Grazzini et al (9) and Zheng et al (10) respectively. However, they are relatively complex and do not form a universally applicable standard.…”