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Preoperative imaging of gastric GISTs underestimates pathologic tumor size: A retrospective, single institution analysis
Author(s) -
Apte Sameer S.,
Radonjic Aleksandar,
Wong Boaz,
Dingley Brittany,
Boulva Kerianne,
Chatterjee Avijit,
Purgina Bibiana,
Ramsay Timothy,
Nessim Carolyn
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26494
Subject(s) - medicine , confidence interval , gist , radiology , endoscopic ultrasound , retrospective cohort study , nuclear medicine , gastroenterology , stromal cell
Background How well imaging size agrees with pathologic size of gastric gastrointestinal stromal tumors (GISTs) is unknown. GIST risk stratification is based on pathologic size, location, and mitotic rate. To inform decision making, the size discrepancy between imaging and pathology for gastric GISTs was investigated. Methods Imaging and pathology reports were reviewed for 113 patients. Bland–Altman analyses and intraclass correlation (ICC) assessed agreement of imaging and pathology. Changes in clinical risk category due to size discrepancy were identified. Results Computed tomography (CT) ( n = 110) and endoscopic ultrasound (EUS) ( n = 50) underestimated pathologic size for gastric GISTs by 0.42 cm, 95% confidence interval (CI): (0.11, 0.73), p = 0.008 and 0.54 cm, 95% CI: (0.25, 0.82), p < 0.001, respectively. ICCs were 0.94 and 0.88 for CT and EUS, respectively. For GISTs ≤ 3 cm, size underestimation was 0.24 cm for CT ( n = 28), 95% CI: (0.01, 0.47), p = 0.039 and 0.56 cm for EUS ( n = 26), 95% CI: (0.27, 0.84), p < 0.0001. ICCs were 0.72 and 0.55 for CT and EUS, respectively. Spearman's correlation was ≥0.84 for all groups. For GISTs ≤ 3 cm, 6/28 (21.4% p = 0.01) on CT and 7/26 (26.9% p = 0.005) on EUS upgraded risk category using pathologic size versus imaging size. No GISTs ≤ 3 cm downgraded risk categories. Size underestimation persisted for GISTs ≤ 2 cm on EUS (0.39 cm, 95% CI: [0.06, 0.72], p = 0.02, post hoc analysis). Conclusion Imaging, particularly EUS, underestimates gastric GIST size. Caution should be exercised using imaging alone to risk‐stratify gastric GISTs, and to decide between surveillance versus surgery.