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.
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T.M. Parab, M.J. DeRogati, A.M. Boaz, et al. (2019) Gastrointestinal stromal tumors: a comprehensive review. J Gastrointest Oncol 10:144–154.
A.D. Levy, H.E. Remotti, W.M. Thompson, L.H. Sobin, M. Miettinen (2003) From the Archives of the AFIP. Gastrointestinal Stromal Tumors: radiologic Features with Pathologic Correlation. Radiographics 23:283–304.
M. Miettinen, J. Lasota (2003) Gastrointestinal Stromal Tumors (GISTs): Definition, Occurrence, Pathology, Differential Diagnosis and Molecular Genetics. Pol J Pathol 54:3–24.
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.
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
H.C. Kim, J.M. Lee, S.H. Kim, et al. (2004) Primary Gastrointestinal Stromal Tumors in the Omentum and Mesentery: CT Findings and Pathologic Correlation. AJR 182:1463–1467.
M. Miettinen, J. Lasota (2006) Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 130:1466–1478.
N. Iorio, R.A. Sawaya, F.K. Friedenberg (2014) Review article: the biology, diagnosis and management of gastrointestinal stromal tumours. Aliment Pharmacol Ther 39:1376–1386.
A.D. Levy, H.E. Remotti, W.M. Thompson, L.H. Sobin, M. Miettinen (2003) Anorectal Gastrointestinal Stromal Tumors: CT and MR Imaging Features with Clinical and Pathologic Correlation. AJR 180:1607–1612.
G. De Manzoni, D. Marrelli, G.L. Baiocchi, et al. (2017) The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer 20:20–30.
R. Grassi, A. Pinto, L. Mannelli, D. Marin, M.A. Mazzei (2016) New Imaging in Gastrointestinal Tract. Gastroenterol Res Pract 2016:5785871. https://doi.org/10.1155/2016/5785871
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].
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].
G.L. Pelandré, M.C. Djahjah, E.L. Gasparetto, M.S. Nacif, E. Marchiori, E.L.R. de Mello (2013) Tomographic findings of gastric gastrointestinal stromal tumor and correlation with the mitotic index. Arq Gastroenterol 50:244–250.
C.D. Fletcher, J.J. Berman, C. Corless, et al. (2002) Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 33:459–465.
H. Joensuu, A. Vehtari, J. Riihimäki J, et al. (2012) Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 13:265–274.
A.C. O’Neill, A.B. Shinagare, V. Kurra, et al. (2016) Assessment of metastatic risk of gastric GIST based on treatment –naive CT features. Eur J Surg Oncol 42:1222–1228.
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.
M.A. Mazzei, V. Nardone, L. Di Giacomo, et al. (2018) The role of delta radiomics in gastric cancer. Quant Imaging Med Surg. 8:719–721.
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.
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.
H.C. Kim, J.M. Lee, K. W. Kim, et al. (2004) Gastrointestinal Stromal Tumors of the Stomach: CT findings and Prediction of Malignancy. AJR 183:893–898.
S. Ulusan, Z. Koc, F. Kayaselcuk (2008) Gastrointestinal stromal tumours: CT findings. Br J Radiol 81:618–623.
S.H. Yin, C.M. Xie, Y.X. Mio, et al. (2009) Correlation of multi-slice spiral CT features to clinicopathologic manifestations of gastrointestinal stromal tumor: a report of 49 cases. Chinese Journal of Cancer 28:1–7.
T. Da Ronch, A. Modesto, M Bazzocchi (2006) Gastrointestinal stromal tumour: spiral computed tomography features and pathologic correlation. Radiol med 111:661–673.
T.V. Bartolotta, A. Taibbi, M. Galia, et al. (2006) Gastrointestinal stromal tumour: 40-row multislice computed tomography findings. Radiol med 111:651–660.
A. Rimondini, M. Belgrano, G. Favretto, A. Spivach, A. Sartori, F. Zanconati (2007) Contribution of CT to treatment planning in patients with GIST. Radiol med 112:691–702.
R. Wada, H. Arai, S. Kure, W.X. Peng, Z. Naito (2016) "Wild type" GIST: Clinicopathological features and clinical practice. Pathol Int. 66:431–437. https://doi.org/10.1111/pin.12431.Review.
A. Gaitanidis, M. El Lakis, M. Alevizakos, A. Tsaroucha, M. Pitiakoudis (2018) Predictors of lymph node metastasis in patients with gastrointestinal stromal tumors (GISTs). Langenbecks Arch Surg. 403:599–606. https://doi.org/10.1007/s00423-018-1683-0.
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].
T. Lehnert (1998) Gastrointestinal sarcoma (GIST): a review of surgical management. Ann Chir Gynaecol. 87:297–305.
T. Tashiro, T. Hasegawa, M. Omatsu, S. Sekine, T. Shimoda, H. Katai (2005) Gastrointestinal stromal tumor of the stomach showing lymph node metastases. Histopathology. 47:438–439. https://doi.org/10.1111/j.1365-2559.2005.02133.x.
S.M. Zwan Van der, R.P. De Matteo (2005) Gastrointestinal stromal tumor. 5 years later. Cancer. 104:1781–1788. https://doi.org/10.1002/cncr.21419.
A.E. Canda, Y. Ozsoy, O.A. Nalbant, O. Sagol (2008) Gastrointestinal stromal tumor of the stomach with lymph node metastasis. World J Surg Oncol. 6:97. https://doi.org/10.1186/1477-7819-6-97.
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.
M.A. Mazzei, F. Gentili, L. Volterrani (2019) Dual-Energy CT Iodine Mapping and 40-keV Monoenergetic Applications in the Diagnosis of Acute Bowel Ischemia: A Necessary Clarification. AJR Am J Roentgenol. 212:W93–W94.
P. Apfaltrer, M. Meyer, C. Meier, et al. (2012) Contrast-enhanced dual-energy CT of gastrointestinal stromal tumors: is iodine-related attenuation a potential indicator of tumor response?” Invest Radiol 47:65–70.
F.G. Mazzei, L. Volterrani, S. Guerrini, et al. (2014) Reduced time CT perfusion acquisitions are sufficient to measure the permeability surface area product with a deconvolution method. Biomed Res Int 2014:573268. https://doi.org/10.1155/2014/573268.
F.G. Mazzei, M.A. Mazzei, N. Cioffi Squitieri, et al. (2014) CT perfusion in the characterisation of renal lesions: an added value to multiphasic CT. Biomed Res Int 2014:135013. https://doi.org/10.1155/2014/135013.
M.A. Mazzei, N. C. Squitieri, E. Sani, et al. (2013) Differences in perfusion CT parameter values with commercial software upgrades: a preliminary report about algorithm consistency and stability. Acta Radiol 54:805–811.
M.A. Mazzei, L. Preda, A. Cianfoni, L. Volterrani (2015) CT perfusion: technical developments and current and future applications”. Biomed Res Int 2015:397521. https://doi.org/10.1155/2015/397521.
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.
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The authors declare that they have no conflict of interest.
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Mazzei, M.A., Cioffi Squitieri, N., Vindigni, C. et al. Gastrointestinal stromal tumors (GIST): a proposal of a “CT-based predictive model of Miettinen index” in predicting the risk of malignancy. Abdom Radiol 45, 2989–2996 (2020). https://doi.org/10.1007/s00261-019-02209-7
- Computed tomography
- Gastrointestinal stromal tumor
- Gastric GIST
- Mitotic index