Long-Term Follow Up of Patients with Small Gastrointestinal Stromal Tumors in the Stomach Using Endoscopic Ultrasonography-Guided Fine-Needle Aspiration Biopsy (original) (raw)
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Endoscopy: possibilities and limitations in the management of GIST of the upper GI tract
Romanian journal of internal medicine = Revue roumaine de médecine interne
Gastrointestinal stromal tumors (GISTs) have been a topic of increasing interest since the discovery of their cellular activation pathway via the receptor for tyrosine kinase (KIT) leading to the possibility of targeted molecular therapy in the form of imatinib mesylate. Endoscopic diagnostic and therapeutic possibilities have also been developing at a rapid pace in recent years. Endoscopic ultrasonography (EUS) allows for an accurate assessment of submucosal tumors and can provide tissue samples for diagnostic purposes using fine needle aspiration techniques. Several newer endoscopic techniques, including contrast enhanced EUS and endoscopic submucosal dissection, have also proven useful in the management of GISTs. Although the many recent studies have focused on the role of endoscopy in diagnosing and treating GISTs, we still need better evidence in order to formulate accurate guidelines.
Gastroenterology Research and Practice, 2012
Although it is possible to visualize gastrointestinal stromal tumors (GIST) of the stomach by endoscopy, their pretreatment histological diagnosis is often difficult. The aim of this study was to investigate predictors of accurate preoperative pathological diagnosis of gastric GIST. Material and Methods. We retrospectively studied patients with gastric GIST who had undergone pretreatment endoscopic biopsy and surgery, and examined their clinicopathological data. Results. Twenty-three patients were eligible. Thirty-four endoscopic biopsies (mean 2.6, range 1-8) were obtained. Preoperative pathological diagnoses of GIST were made in 18 patients. Precise diagnoses were made in 18 (52.9%) of the 34 biopsies. Endoscopic ultrasound (EUS) resulted in precise diagnoses in 11 (91.7%) of the 12 biopsy specimens. Fine-needle aspiration (FNA) biopsy resulted in precise diagnoses in 11 (84.6%) of the 13 biopsy specimens. The accuracy of pathological diagnosis by EUS-guided FNA biopsy was 100%. The procedure of EUS-guided FNA biopsy had no complications or recurrent disease. In a multivariate analysis, only EUS achieved a significantly superior rate of diagnosis (odds ratio, 11.884; 95% confidence interval, 1.204-289.230; P = 0.034). Conclusion. EUSguided FNA biopsy is the most accurate for pretreatment pathological diagnosis of gastric GIST and for prevention of both of early complications and disease recurrence.
Surgical Treatment of Gastrointestinal Stromal Tumors (GISTs)
InTech eBooks, 2012
However, when esophagogastric or duodenal subepithelial nodules with < 2 cm diameter are detected, the standard procedure consists in endoscopic ultrasound (EUS) assessment and active surveillance of the individual patient, because many of these small nodules, when they correspond to GISTs, are tumors of low biological risk (Fletcher, Berman et al. 2002; Miettinen and Lasota 2006) or whose clinical behavior remains to be clarified. Surgery is reserved for patients whose tumor increases in dimension or is symptomatic. The results of a recent retrospective analysis (Lok, Lai et al. 2009) indicate that only some (3 out of 23; 13.0%) of the small tumors without high-risk EUS characteristics (large dimension, irregular extraluminal limits, heterogeneous echo pattern, presence of cystic areas, and hyperechoic foci) progressed during the long-term follow-up with EUS. As an alternative, the decision can be shared in an individual base with the patient, either to opt for an initial histological evaluation (needle biopsy) or for the tumor excision, when the morbidity is not substantial. On the other hand, when facing intra-abdominal nodules without endoscopic evaluation, the laparoscopy/laparotomy resection is the standard approach. Also for rectal nodules (or in the recto-vaginal space), the best management must be the accomplishment of biopsy/resection, after EUS evaluation, regardless of the tumor dimension, because GISTs in this location display high biological risk, and the local implications of a surgical intervention in this region is more critical, mostly in tumors of great dimensions. The guidelines of the ESMO and the NCCN coincide in the recommendation that tumors with dimension > 2 cm must be resected (Casali and Blay 2010; Demetri, von Mehren et al. 2010), because being GISTs, they imply a higher risk of aggressive behavior. For patients with localized primary GIST, the surgical resection continues to be the only possibility of cure of their illness. In our experience we obtained complete macroscopic resection (R0 or R1) in 92.3% of GISTs and microscopic negative margins (R0) in 75% of cases. 5-year disease-specific survival (DSS) and recurrence-free survival (RFS) was 87.7% and 89.8%, respectively, after surgical resection of patient's primary GIST. The recurrence rate was significantly (p=0.045) lower in R0 cases. In the multivariate analysis, only the presence of macroscopic residual tumor (R2) was significantly associated (p=0.013) with shorter DSS (Gouveia, Pimenta et al. 2008). The DSS and RFS values in our patients fit with results published in other studies (
The Egyptian Journal of Hospital Medicine, 2020
Background: Submucosal lesion is a mass or bulge covered by normal-appearing mucosa identified during standard endoscopy. Endoscopic Ultrasound (EUS) allows precise differentiation of the individual layers of the gastrointestinal (GI) tract. Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) permits safe and accurate sampling of submucosal lesions (SMLs) for further histopathology. Gastrointestinal stromal tumors are the commonest mesenchymal neoplasms of the GI tract. They should be stratified by malignant potential according to tumor size, location, and mitotic count. Objectives: The aim of work was to evaluate the role of endoscopic ultrasound with EUS-FNA in management of submucosal gastrointestinal lesions, with special concern about gastrointestinal stromal tumors (GISTs) lesions and the criteria highly associated with malignant nature. Patients and methods: This multi-center prospective study included a total of 150 patients with gastrointestinal submucosal lesions, conducted to evaluate EUS and EUS-FNA as diagnostic tools of submucosal lesions, including 68 GIST lesions. All patients underwent conventional endoscopy, EUS-FNA and histopathological examination of the samples obtained in Theodor Bilharz Research Institute, Cairo University Hospital and Kobry El Qubba Military Hospital from 2015 to 2017. Results: There were 150 patients with submucosal GI lesions, including 93(62%) males and 57(38%) females, with the mean age of 52±11.9 years. Presentations included dyspepsia 73(48.7%), asymptomatic SMLs 31(20.7%). The lesions were mainly gastric 102(68%). Final diagnoses were GIST 68 (45.3%), lipoma 11(7.3%), leiomyoma 9(6%) and extramural lesions 7(4.7%). There were 68 patients with GIST lesions, including 43(63.2%) males and 25(36.8%) females, with the mean age of 54±10.3 years. Presentations included dyspepsia 41(63.2%), asymptomatic SMLs 16(23.5%). The lesions were mainly gastric 57(83.8%). Sensitivity and specificity were 88.6% and 100% of EUS-FNA as diagnostic tools for GIST lesions respectively. (PPV) and (NPV) were 100% and 82.8% respectively. Conclusion: It could be concluded that EUS and EUS-FNA were highly significant methods in diagnosis of GIST lesions in relation to final histopathology.
Gastroenterology Research and Practice, 2018
Aims. To review the clinical presentation, diagnosis, assessment of risk of malignancy, and recent advances in management (mainly focusing on the role of endoscopic resection) of gastrointestinal stromal tumors (GISTs) in upper GI.Method. We searched Embase, Web of science, and PubMed databases from 1993 to 2018 by using the following keywords: “gastrointestinal stromal tumors,” “GIST,” “treatment,” and “diagnosis.” Additional papers were searched manually from references of the related articles.Findings. The improvement of endoscopic techniques in treating upper gastrointestinal subepithelial tumors especially gastrointestinal tumors has reduced the need for invasive surgery in patients unfit for surgery. Many studies have concluded that modified endoscopic treatments are effective and safe. These treatments permit minimal tissue resection, better dissection control, and high rates of en bloc resection with an acceptable rate of complications.
Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors
Gastrointestinal Endoscopy, 2010
Background: GI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial. Objective: The aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs. Design: Prospective case series. Setting: Academic medical center. Patients: Eight patients with submucosal gastric tumors Ͻ2 cm in diameter suspected to be GISTs. Interventions: Endoscopic ligation and resection. Main Outcome Measurements: Clinical/technical feasibility, success, and adverse events. Results: Seven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred. Limitations: Small number of patients (n ϭ 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign. Conclusions: Endoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method. GI stromal tumors (GISTs) are common submucosal tumors of the stomach with the potential for malignant transformation, which are usually treated surgically. 1-3 Asymptomatic GISTs Ͻ2 cm in diameter are considered to be of low malignant potential; however, the management of these small GISTs remains uncertain. Small lesions may gradually grow, produce symptoms, and undergo malignant transformation. 4-6 Moreover, the presence of a GIST, which necessitates lifelong follow-up, can be a source of psychologic stress. An endoscopic approach is less invasive than open surgical or laparoscopic interventions; however, endoscopic treatment of GISTs has not been well established. 7,8 A minimally invasive technique that can diagnose and remove small GISTs with a low incidence of procedure-related complications would be a useful new option for physicians and patients. Here, we report development of a new method of combined endoscopic ligation and resection that shows promise for the diagnosis and treatment of patients with small EUS-suspected gastric GISTs. The aim of this study was to prospectively evaluate both the feasibility and the safety of the method. PATIENTS AND METHODS Patients A total of 8 patients (2 men, 6 women; median age, 54 years; range, 45-71 years) who were scheduled to undergo Abbreviations: GIST, GI stromal tumor.
An audit of surgical management of gastrointestinal stromal tumours (GIST)
European Journal of Surgical Oncology (EJSO), 2006
Aim: To analyze GIST outcome after primary resection and to determine if a new grading system could adequately predict there prognosis. Methods: A retrospective review (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) identified 80 patients who underwent primary surgical resection for, c-KIT positive, GIST. Follow-up was complete for all patients (median follow-up 42, range 1-132, months). GIST were classified as low or high grade according to the following parameters: size, mitotic rate, mitotic index (MiB1), presence of necrosis, invasion of adjacent structure and presence of metastasis. Results: GIST originated from the stomach (46), small bowel (30), colon and rectum two and mesentery two. At surgery, 94% of cases presented with localized disease and 6% blood born metastasis with or without lymph node invasion. Resections were complete (R0) in 72 cases. R0 resection correlated with prognosis (p!0.01). Sixty GIST were classified as low grade (median follow-up 60 months) and 20 as high grade (median follow-up 27 months). Five-year actuarial survival of patients with low or high grade GIST were of 95 and 21%, respectively, (p!0.001). Conclusion: Prognosis of GIST after surgical treatment is influenced by completeness of primary resection and tumour malignant potential. Low grade GIST have an excellent prognosis after surgery alone, while high grade GIST have a high rate of recurrence after primary resection. Adjuvant treatment should be advocated for patient with either high grade GIST or after incomplete primary resection. The presented grading system can reliably predict GIST outcome after primary surgical treatment.
Unusual presentation of a large GIST: a challenging diagnostic dilemma
Bangladesh Critical Care Journal
Introduction: Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated withhigh rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computedtomography (CT) scan and most stain positive for CD 117 (C-Kit), CD34, and/ or DOG-1. There have been many riskstratification classifications systems which are calculated based on tumor size, mitotic rate, location and perforation. Case presentation: A 42 years old man presented with dysphagia and weight loss for 2.5 months. On examination, hewas severely anaemic having a huge intra-abdominal lump. He underwent laparotomy followed by removal of tumormass with partial left lobectomy of the Liver. Conclusion:We present a case of GIST of unusual location and presentation pattern. In general, only completeresection of tumor can lead to cure, although recurrence is common after surgery. Bangladesh Crit Care J March 2023; 11 (1): 54-60