The Correlation Study Of CT Findings With Ki-67 Labeling Index In Gastrointestinal Stromal Tumor

Objective To evaluate the correlation of Computed tomography(CT)imaging findings with Ki-67 labeling index in gastrointestinal stromal tumor(GIST),According to the different CT imaging findings and pathologic and immunohistochemical results of GIST.Methods A retrospective analysis was performed on 167 patients with primary GIST hospitalized and operated in the affiliated hospital of Qingdao university from October2016 to May 2019.All patients underwent plain CT scan and CT enhancement examination before operation.The complete clinical date,pathological date and CT imaging findings have been obtained.Observe the feature of GIST tumor in CT scan and enhancement include primary site(in gastrointestinal or extragastrointestinal),presence of metastasis(lymph node metastasis,remote organs metastasis or peritoneal planting metastasis),tumor shape(regular or irregular),growth pattern(endoluminal,exophytic or mixed),presence of calcification,presence of necrosis,presence of hemorrhage and the density of tumors.Long diameter(LD),short diameter(SD),plain scan and enhanced CT values of tumors were measured.The clinical data included gender,age and first symptom.The pathological data included mitotic figures(50/HPF)and the labeling index of Ki-67,CD34,CD117,dog-1,etc.Analyze all the data by SPSS 22.0 statistical software.(1)According to the Ki-67 labeling index,all 167 GIST patients were divided into four groups:extremely low expression(positive cells ? 3%),low expression(positive cells4%-5%),moderate expression(positive cells 6%-10%)and high expression(positive cells>10%).(2)Analyze CT imaging findings with statistical significance in different Ki-67 groups by Mann-Whitney U test or Kruskal-Wallis test.(3)Spearman rank correlation coefficient was used to analyze the correlation between each CT quantitative data and Ki-67 labeling index.(4)Independent factors influence Ki-67 labeling index were screened out by logistic regression analysis.(5)The Kappa consistency check was used to evaluate the consistency of Ki-67 index classification with the 2008 modified NIH risk stratification for GIST.Results(1)According to the Ki-67 labeling index,all 167 GIST patients were divided into four groups:67 cases(40.1%)were extremely low expression,44 cases(26.3%)were low expression,30 cases(18.0%)were moderate expression and 26 cases(15.6%)were high expression.(2)There were CT imaging findings include primary site,presence of metastasis,tumor shape,growth pattern,presence of calcification,presence of necrosis,presence of hemorrhage,enhancement mode,Long diameter(LD),plain scan have statisticallysignificant with Ki-67 labeling index(Mann-Whitney U test or Kruskal-Wallis test,P<0.05).Gender,age,LD/SD(Short diameter),absolute CT values(Ap,Vp,Dp)of GIST don't have statistically significant with Ki-67 labeling index(Mann-Whitney U test or Kruskal-Wallis test,P>0.05).(3)There were CT imaging findings include primary site,presence of metastasis,tumor shape,growth pattern,presence of calcification,presence of necrosis,presence of hemorrhage,enhancement mode and Long diameter(LD)have statistically significant with Ki-67 labeling index(logistic regression analysis,P<0.05).Plain scan,LD/SD(Short diameter),absolute CT values(Ap,Vp,Dp)of GIST don't have statistically significant with Ki-67 labeling index(logistic regression analysis,P>0.05).(4)Do kappa test between the Ki-67 expression groups in GIST and the NIH risk classification criteria.The results were statistically significant(P<0.05).Conclusion In the CT findings of GIST,Ki-67 was highly expressed in the EGIST(extragastrointestinal stromal tumor).In GIST with metastasis,Ki-67 was highly expressed,indicating that the tumor had a higher malignant biological behavior.In GIST with irregular shape,the expression of Ki-67 was high,indicating that the tumor proliferation activity was high.The expression of Ki-67 was low in endogenic growth GIST,suggesting that the tumor might have low malignant biological behavior.For GIST with calcification,hemorrhage and necrosis,the expression of Ki-67 was higher.There was a moderately positive correlation between LD and the expression of Ki-67,the greater LD has higher expression of Ki-67.The expression of Ki-67 was higher in GIST,which was not uniformly in CT enhancement.The primary site,presence of metastasis,tumor shape,growth pattern,presence of calcification,presence of necrosis,presence of hemorrhage,enhancement mode and Long diameter(LD)of GIST tumors were independent factors affecting Ki-67 expression groups.Ki-67 expression groups in GIST was consistent with the NIH risk classification criteria,which could be used as a supplement to the NIH risk classification criteria.In summary,the CT findings of GIST have certain characteristics.A number of CT findings are significantly correlated with the expression of Ki-67,which is of certain guiding significance for predicting the malignant potential and prognosis of GIST.