Analysis of the characteristics of gastrointestinal stromal tumors and leiomyomas by endoscopic ultrasound, multi-slice spiral CT, and immunohistochemistry

Abstract

Objective The characteristics of gastrointestinal stromal tumor (GIST) and leiomyoma (LM) in EUS, multi-slice spiral CT (MSCT), and immunohistochemistry were analyzed, and the differential diagnosis of EUS, MSCT, and immunohistochemistry was evaluatedvalue. Methods In the endoscopic center of our hospital from April 2013 to June 2019, general gastroscopy and EUS examinations were performed, and the submucosal lesions of the digestive tract resected by ESD/EMR/EFR were diagnosed as GIST or LM by pathology and immunohistochemistry. Sixty-seven patients with complete data records were included in the retrospective study. The characteristics of the lesions in gastroscopy, EUS, MSCT, and immunohistochemistry were analyzed, and the conformity of EUS, MSCT and pathology was evaluated. Results 43 cases of LM and 24 cases of GIST were diagnosed by pathology and immunohistochemistry. The diagnosis of 44 cases of EUS was consistent with the pathological results, with a coincidence rate of 65.7%(44/67). The accuracy rates of GIST and LM diagnosis were 67.2% and 71.6%, respectively. The diagnosis of 23 cases did not match the pathology(EUS misdiagnosed 17 cases of LM as GIST, 1 case of GIST as LM, 5 cases of EUS were not clearly classified, and 4 cases of GIST and 1 case of LM were diagnosed after surgery). There was no significant difference in the average size, shape, defoliation, and surface condition of the GIST and LM lesions under EUS (P> 0.05); compared with the lesion site, origin level, echo, growth pattern, and calcification, the differences Statistically significant(P<0.05). Among 67 cases, 56 cases(35 cases of LM and 21 cases of GIST)underwent MSCT examination. The EUS diagnosis coincidence rate was 58.9%(33/56), which was higher than the MSCT coincidence rate of 17.9%(10/56). The positive rates of Desmin and SMA of LM were higher than those of GIST, and the positive rates of CD34, CD117 and DOG-1 of GIST were higher than those of LM (P<0.05). Conclusions The diagnosis of GIST and LM under EUS is easy to be confused. The diagnostic accuracy of the two is similar, but the diagnosis rate of LM and GIST by EUS is significantly higher than that of MSCT. The diagnostic accuracy of MSCT for stromal tumors is higher than LM. Good discrimination between LM and GIST. Key words: Digestive tract; Stromal tumor; Leiomyomas; EUS; MSCT; Characteristic analysis