Update on Gastrointestinal Stromal Tumors for Radiologists

Tirumani, Sree Harsha; Baheti, Akshay D.; Tirumani, Harika; O’Neill, Ailbhe C.; Jagannathan, Jyothi P.

doi:10.3348/kjr.2017.18.1.84

Cited by 31 publications

(31 citation statements)

References 48 publications

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“…Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors. Risk stratification of GISTs tries to evaluate the risk of poor outcome and to choose patients who may benefit from adjuvant therapy [1]. Although criteria may vary from country to country, the 2008 National Institute of Health (NIH) criteria are the most widely used.…”

Section: Introductionmentioning

confidence: 99%

Risk stratification in GIST: shape quantification with CT is a predictive factor

Wei

Liang

et al. 2020

Eur Radiol

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Background Tumor shape is strongly associated with some tumor's genomic subtypes and patient outcomes. Our purpose is to find the relationship between risk stratification and the shape of GISTs. Methods A total of 101 patients with primary GISTs were confirmed by pathology and immunohistochemistry and underwent enhanced CT examination. All lesions' pathologic sizes were 1 to 10 cm. Points A and B were the extremities of the longest diameter (LD) of the tumor and points C and D the extremities of the small axis, which was the longest diameter perpendicular to AB. The four angles of the quadrangle ABCD were measured and each angle named by its summit (A, B, C, D). For regular lesions, we took angles A and B as big angle (BiA) and small angle (SmA). For irregular lesions, we compared A/B ratio and D/C ratio and selected the larger ratio for analysis. The chi-square test, t test, ROC analysis, and hierarchical or binary logistic regression analysis were used to analyze the data. Results The BiA/SmA ratio was an independent predictor for risk level of GISTs (p = 0.019). With threshold of BiA at 90.5°, BiA/SmA ratio at 1.35 and LD at 6.15 cm, the sensitivities for high-risk GISTs were 82.4%, 85.3%, and 83.8%, respectively; the specificities were 87.1%, 71%, and 77.4%, respectively; and the AUCs were 0.852, 0.818, and 0.844, respectively. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could (p < 0.05). Shape and Ki-67 were independent predictors of the mitotic value (p = 0.036 and p < 0.001, respectively), and the accuracy was 87.8%. Conclusions Quantifying tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs, especially for high-risk grading and mitotic value > 5/50HPF. Key Points • The BiA/SmA ratio was an independent predictor affecting the risk level of GISTs. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could. • Shape and Ki-67 were independent predictors of the mitotic value.• The method for quantifying the tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs.

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Section: Introductionmentioning

confidence: 99%

Risk stratification in GIST: shape quantification with CT is a predictive factor

Wei

Liang

et al. 2020

Eur Radiol

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“…Zhou et al . regarded EVFDM as a predictor for risk stratification 12 , although the exact mechanism underlying this relationship is unclear and needs further study 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Association between CT imaging features and KIT mutations in small intestinal gastrointestinal stromal tumors

Yin

Liu

Zhang

et al. 2019

Sci Rep

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Small intestinal gastrointestinal stromal tumors (GISTs) have different clinical outcomes when KIT mutations are in exons 11 or 9, which are also the most common sites of neoplastic KIT mutations. The purpose of this study is to evaluate the CT imaging features in those two groups. A total of 35 patients were enrolled, and both quantitative and qualitative CT imaging features were compared between patient groups with KIT exon 9 mutations (KIT–9) and exon 11 mutations (KIT–11). The KIT–9 group was statistically associated with a tumor size larger than 10 cm and a higher enhancement ratio when compared with those of the KIT–11 group (both P < 0.05). For the enhancement ratio, the receiver operating characteristic curve indicated a cut-off value of 1.60 to differentiate KIT–9 from KIT–11 tumors. Additionally, tumor necrosis was more commonly seen in the KIT-9 group. In multivariate analysis, tumor size (β = 0.206; P = 0.022) and KIT–9 (β = 0.389; P = 0.006) were independent factors associated with tumor necrosis. Taken together, KIT–9 mutant tumors tended to have CT imaging features indicative of more aggressive neoplasms. These findings may be helpful in identifying more aggressive small intestinal GISTs and optimizing treatment.

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“…However, the response was unique as compared with conventional chemotherapy as there was often little initial shrinkage in the tumor size, but with dramatic decrease in tumor enhancement and inhomogeneity. 1,2 The tumors appeared well defined, homogeneous, and hypodense (almost cystic in appearance) after initiation of treatment with imatinib. This is due to the development of cystic or myxoid change within the tumor without significant necrosis or inflammation.…”

Section: Therapy-specific Criteria Choi Criteriamentioning

confidence: 99%

Tumor Response Criteria in Oncoimaging: RECIST Criteria and beyond—Part 2

Baheti

Rastogi

Natarajan

et al. 2019

Journal of Gastrointestinal and Abdominal Radiology

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The rapid recent advances in oncology have made the dream of precision oncology a reality, with targeted therapy available for various tumors depending on the molecular genotype. This has led to the corresponding development of personalized radiology as well, with various tumor response criteria used to characterize disease response/progression depending on chemotherapy used. In these two review articles, we review the various tumor response criteria widely applied in both research and clinical settings. These include the classic size-based criteria such as RECIST (Response Evaluation Criteria In Solid Tumors) 1.1 and the WHO (World Health Organization) criteria, as also various other criteria such as Choi and modified Choi criteria for tumors treated by targeted therapy, EASL (European Association for the Study of the Liver) and modified RECIST (mRECIST) criteria for hepatocellular carcinomas, immune-related response criteria (irRC) and immune RECIST (iRECIST) for patients on immunotherapy. Other clinically important criteria such as PERCIST (PET Response Criteria In Solid Tumors) for positron emission tomography–computed tomography (PET-CT), and the MD Anderson criteria for evaluating bone metastases are also highlighted.

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Update on Gastrointestinal Stromal Tumors for Radiologists

Cited by 31 publications

References 48 publications

Risk stratification in GIST: shape quantification with CT is a predictive factor

Risk stratification in GIST: shape quantification with CT is a predictive factor

Association between CT imaging features and KIT mutations in small intestinal gastrointestinal stromal tumors

Tumor Response Criteria in Oncoimaging: RECIST Criteria and beyond—Part 2

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