Correlation between endoscopic ultrasonography and enhanced CT features and pathological risk of gastric stromal tumors
10.3760/cma.j.cn321463-20240401-00127
- VernacularTitle:胃间质瘤超声内镜及增强CT特征与病理危险度的相关性研究
- Author:
Yuhao WANG
1
;
Lei SHEN
1
Author Information
1. 武汉大学人民医院消化内科 消化系统疾病湖北省重点实验室，武汉 430060
- Publication Type:Journal Article
- Keywords:
Ultrasonography;
Gastrointestinal stromal tumors;
Gastric stromal tumors;
Pathological risk;
Enhanced computed tomography
- From:
Chinese Journal of Digestive Endoscopy
2025;42(1):53-59
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the correlation between endoscopic ultrasonography (EUS) and enhanced computed tomography (CT) image features and pathological risk of gastric stromal tumors (GSTs).Methods:Data of primary GSTs patients treated at Renmin Hospital of Wuhan University from January 2018 to November 2022, confirmed by endoscopy or surgical pathology and immunohistochemistry were retrospectively reviewed. A total of 286 cases (288 lesions) underwent EUS before surgery, of which 70 cases (71 lesions) had complete preoperative enhanced CT examination data. Patients who underwent EUS were divided into relatively benign group (including very low-risk and low-risk, 245 cases of 247 lesions) and relatively malignant group (including intermediate-risk and high-risk, 41 cases of 41 lesions) based on the pathological risk of GSTs. Patients who underwent enhanced CT examination were also divided into relatively benign group (38 cases of 39 lesions) and relatively malignant group (32 cases of 32 lesions) based on the pathological risk of GSTs. Univariate analysis and multivariate logistic regression analysis were used to explore the independent risk factors associated with the malignant potential of GSTs based on EUS and enhanced CT imaging features.Results:(1) Univariate analysis showed that there were significant differences among groups in terms of ulceration presence on lesion surface, long diameter, boundary regularity, internal echo uniformity and cystic change under EUS ( P<0.05). Logistic regression analysis showed that ulcers on the lesion surface ( P=0.010, OR=4.519, 95% CI:1.432-14.257) and lesion long diameter ( P<0.001, OR=2.398, 95% CI:1.688-3.406) under EUS were independent risk factors for GSTs relative to malignancy. The result of receiver operator characteristic (ROC) curve analysis of GSTs long diameter predicting pathological risk relative to malignancy under EUS showed the area under curve (AUC) was 0.891 (95% CI: 0.839-0.943), the maximum Youden index was 0.667, and the corresponding long diameter of lesion was 1.55 cm. In this case, the sensitivity and specificity of predicting the pathological risk of GSTs were 90.2% and 76.5%, respectively. (2) Univariate analysis showed that there were significant differences in lesion long diameter, shape (round or quasi-round/irregular), boundary clarity, enhancement pattern, and necrosis under enhanced CT among groups ( P<0.05). Logistic regression analysis showed that lesion long diameter under enhanced CT ( P=0.010, OR=2.533, 95% CI:1.245-5.154) was an independent risk factor for GSTs relative to malignancy. The ROC curve analysis of GSTs long diameter predicting pathological risk relative to malignancy under enhanced CT showed that AUC was 0.824 (95% CI: 0.724-0.924), the maximum Youden index was 0.560, and the corresponding long diameter of the lesion was 3.65 cm. The sensitivity and specificity of predicting the pathological risk of GSTs were 68.8% and 87.2%, respectively. Conclusion:The long diameter of GSTs under EUS and enhanced CT exhibits a significant association with the pathological risk of GSTs, which can be used to predict the relative malignancy of GSTs (medium to high risk).
