Application Of Endoscopic Ultrasound In The Diagnosis And Therapy Of Small Gastric Stromal Tumors

Background: At present,there is no consensus on the need for treatment of gastric stromal tumors less than 2 cm in diameter.Endoscopic ultrasound(Endoscopic Ultrasound,EUS)can provide a preliminary basis for the classification of disease risk.However,it is still necessary to further analyze whether EUS image features can accurately evaluate the risk classification of gastric small stromal tumors.Aim: Endoscopic ultrasound(EUS)can provide a preliminary basis for judging the risk degree of lesions.Thus,the aim of this study was to determine the management of small gastric GISTs by evaluating the diagnostic effectiveness of EUS in small GISTs.Methods: We collected the data of patients with GISTs(diameter ≤2.0 cm)who were admitted to Shengjing Hospital of China Medical University between September 2014 and July 2019.The patients’ diagnoses were confirmed through pathological assessment after resection.Endoscopic ultrasonographic features,such as marginal irregularity,cystic changes,etc.,were retrospectively analysed to judge the malignancy potential of the tumours and then compared with the pathological features.The findings were statistically analysed.Results: A total of 256 patients(69 males and 187 females)were enrolled.Among them,247 cases underwent endoscopic resection with an average age of 57±8 years and an average diameter of 1.02±0.42 cm,and 9 cases underwent laparoscopic resection with an average age of 58±12 years and an average diameter of 1.57±0.37 cm.The locations of the lesions were as follows: 204 cases of gastric fundus,43 cases of gastric body,7 cases of gastric antrum and 2 cases of cardia.Pathological results showed that there were 243 cases of very low risk,8 cases of low risk,4 cases of medium risk,and 1 case of high risk.The sensitivity,specificity,false negative rate,and false positive rate of the cohort were 60%,65.74%,40%,and 34.26%,respectively.The positive likelihood ratio,negative likelihood ratio,and Youden’s index for evaluating the malignancy potential of GISTs by EUS alone were 1.75,0.61,and 0.26 respectively.The area under the receiver operating characteristic curve(Az)was 0.629.None of the 247 patients underwent endoscopic resection had serious postoperative adverse reactions.No patient had any recurrence or metastasis during the follow-up period.Conclusions: Although endoscopic resection is safe and effective,the malignancy potential of small GISTs cannot be accurately evaluated based on EUS image features alone.The lesions still need to be removed to determine their pathological features and guide further treatment.