Gastrointestinal stromal tumors (GIST): a proposal of a “CT-based predictive model of Miettinen index” in predicting the risk of malignancy
To identify the predictors of malignancy on CT for the evaluation of gastrointestinal stromal tumors (GIST) by correlating CT findings with the mitotic index in order to propose a “CT-based predictive model of Miettinen index.”
One radiologist and one resident in radiology with 14- and 4-year experience in oncological field reviewed the CT findings of 42 patients by consensus, with respect to lesion site, size, contour, tumor growth pattern, enhancing pattern, degree of enhancement of tumor, percentage of tumor necrosis, mesenteric fat infiltration, ulceration, calcification, regional lymphadenopathy, direct invasion to adjacent organs, and distant metastasis. All parameters were correlated with the mitotic index evaluated at histopathological analysis following surgery. Normality of variables was evaluated using Shapiro–Wilk test. Pearson’s correlation test was used to assess the interaction between variables. The diagnostic accuracy percentage of tumor necrosis was measured by receiver operating characteristic (ROC) analysis for detecting whether the number of mitosis per 50 high-power fields was > 5.
A significant statistical correlation was found between percentage of tumor necrosis and the mitotic index (p < 0.005), dimension, and location of the tumor.
CT could be an accurate technique in the prediction of malignancy of GIST in a CT risk assessment system, based on the location of the tumor, its size, and the percentage of tumor necrosis.
KeywordsComputed tomography Gastrointestinal stromal tumor Gastric GIST Mitotic index
A preliminary research with the title “Gastrointestinal stromal tumors of the stomach: CT percentage of tumor necrosis and prediction of malignancy” was presented as conference abstract at ECR 2015, Book of Abstracts—B—Scientific Sessions and Late-Breaking Clinical Trials.
No funding was obtained for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the local institutional review board.
- 3.M. Miettinen, J. Lasota (2003) Gastrointestinal Stromal Tumors (GISTs): Definition, Occurrence, Pathology, Differential Diagnosis and Molecular Genetics. Pol J Pathol 54:3–24.Google Scholar
- 4.M. Bosoteanu, C. Bosoteanu, M. Deacu, M. Aschie (2011) Differential diagnosis of gastric stromal tumor: case report and literature review. Rom J Morphol Embryol 52:1361–1368.Google Scholar
- 5.M.A. Mazzei, G. Bagnacci, F. Gentili, et al. (2018) Gastric Cancer Maximum Tumour Diameter Reduction Rate at CT Examination as a Radiological Index for Predicting Histopathological Regression after Neoadjuvant Treatment: A Multicentre GIRCG Study. Gastroenterol Res Pract 2018:1794524. https://doi.org/10.1155/2018/1794524 CrossRefGoogle Scholar
- 7.M. Miettinen, J. Lasota (2006) Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 130:1466–1478.Google Scholar
- 12.T. Chen, L. Xu, X. Dong, Y. Li, J. Yu, W. Xiong, G. Li (2019) The roles of CT and EUS in the preoperative evaluation of gastric gastrointestinal stromal tumors larger than 2 cm. Eur Radiol. https://doi.org/10.1007/s00330-018-5945-6. [Epub ahead of print].
- 13.M. Liu, L. Liu, E. Jin (2018) Gastric sub-epithelial tumors: identification of gastrointestinal stromal tumors using CT with a practical scoring method. Gastric Cancer. https://doi.org/10.1007/s10120-018-00908-6. [Epub ahead of print].
- 15.C.D. Fletcher, J.J. Berman, C. Corless, et al. (2002) Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 33:459–465.Google Scholar
- 18.M.R. Ambrosio, B.J. Rocca, M.G. Mastrogiulio, et al. (2014) Cystic gastrointestinal stromal tumors of the pancreas simulating cystoadenocarcinoma. Report of three cases and short review of the literature. Histol Histopathol 29:1583–1591.Google Scholar
- 20.I.G. Lupescu, M. Grasu, M. Boros, et al. (2007) Gastrointestinal Stromal Tumors: Retrospective Analysis of the Computer-Tomographic Aspects. J Gastrointestin Liver Dis 16:147–151.Google Scholar
- 21.T.H. Yang, J.I. Hwang, M.S. Yang, S.W. Hung, S.W. Chan, Jwang, Y.S. Tyan (2007) Gastrointestinal Stromal Tumors: Computed Tomographic Features and Prediction of Malignant Risk from Computed Tomographic Imaging. J Chin Med Assoc 70:367–373.Google Scholar
- 30.N. Gong, C.S. Wong, Y.C. Chu (2011) Is lymph node metastasis a common feature of gastrointestinal stromal tumor? PET/CT correlation. Clin Nucl Med. 36:678–682. https://doi.org/10.1097/rlu.0b013e318219ad31. Erratum in: Clin Nucl Med. 2011; 36:833. Jie, Gong Nan [corrected to Gong, Nanjie]; Sing, Wong Chun [corrected to Wong, Chun Sing]; Ching, Chu Yiu [corrected to Chu, Yiu Ching]; Tiffany [removed].
- 31.T. Lehnert (1998) Gastrointestinal sarcoma (GIST): a review of surgical management. Ann Chir Gynaecol. 87:297–305.Google Scholar
- 35.A. Shafizad, M. Mohammadianpanah, H. Nasrolahi, M. Mokhtari, S.A. Mousavi (2014) Lymph Node Metastasis in Gastrointestinal Stromal Tumor (GIST): to Report a Case. Iran J Cancer Prev. 7:171–174.Google Scholar