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

医学 主旨 回声 平滑肌瘤 神经鞘瘤 内镜超声检查 间质细胞 平滑肌肉瘤 放射科 间质瘤 病理 内科学 胃肠病学 内窥镜检查 超声科
作者
Shotaro Okanoue,Masaya Iwamuro,Takehiro Tanaka,Takuya Satomi,Kenta Hamada,Hiroyuki Sakae,Makoto Abe,Yoshiyasu Kono,Hiromitsu Kanzaki,Seiji Kawano,Yoshiro Kawahara,Hiroyuki Okada
出处
期刊:Medicine [Wolters Kluwer]
卷期号:100 (40): e27520-e27520 被引量:9
标识
DOI:10.1097/md.0000000000027520
摘要

Abstract There is no practical predictive model for the diagnosis of gastrointestinal stromal tumors (GISTs). To establish a practical predictive model for the diagnosis of subepithelial lesions in the stomach, we reviewed patients with GISTs (n = 89), schwannomas (n = 7), and leiomyomas (n = 28). The tumor was more frequently found along the gastric cardia in the leiomyoma group (57.1%) than in the GIST/schwannoma group (2.1%, P < .01). Contrast enhancement (57.3% vs 0%, P < .01) and intra-tumoral necrosis (34.4% vs 0.0%, P < .01) were more frequently observed in the GIST/schwannoma group than in the leiomyoma group. On endoscopic ultrasonography, 58.3% of GISTs/schwannomas showed uneven echogenicity, whereas the echogenicity was uneven in 21.4% of leiomyomas ( P < .01). There were no differences between the tumor color and the presence or absence of ulcer formation, tumor bleeding, irregularity of the tumor margin, cystic spaces, and hyperechoic spots between the 2 groups. Based on these results, we developed a 2-step diagnostic algorithm for GISTs/schwannomas. The first step comprises 1 endoscopic feature: a cardiac or non-cardiac location. Tumors with a cardiac location were judged as leiomyomas and those with a non-cardiac location were judged as GISTs/schwannomas, with 96.9% sensitivity and 57.1% specificity for GIST/schwannoma diagnosis. The second step comprises a combination of endoscopic (non-cardiac location), radiologic (positive contrast enhancement and intra-tumoral necrosis), and endosonographic (uneven echogenicity) features for a total of 4 points. We assigned 1 point to each feature. Tumors with scores of 2 to 4 were judged as GISTs/schwannomas, with 81.3% sensitivity and 92.9% specificity for GIST/schwannoma diagnosis. Our predictive model will be a practical guide for the management of gastric subepithelial lesions.
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