Low Risk Of Malignancy Research Articles

P2.30 Six Months Neoadjuvant Imatinib Improves Resectability Potential of Gastric Stromal Tumors in Egyptian Patients

ABSTRACT Objectives Though recurrence is high, local excision is the preferred approach for dealing with gastric stromal tumors. Achieving negative margins is mandatory, sometimes requiring subtotal gastrectomy. Adjuvant imatinib is essential for advanced cases and prolonging survival; however, there is not enough data to recommend its use before surgery to increase resectability. The current study aims at investigating this concept in Egyptian patients. Patients and methods The study included 16 patients (13 males, 3 females, mean age 60 years) presenting with gastrointestinal stromal tumors (GISTs) who were candidates for emergency (n = 3) or elective (n = 13) surgery. Investigations included endoscopy (+biopsy), sonography, and computed tomography (CT). Patients were enrolled in two groups: A (n = 6: projected to planned surgery) and B (n = 7: harboring c-kit +ve tumors). Each B patient received imatinib (400 mg/day) for 6 months before surgery. Clinical and radiological evaluation was at day 100. The Chi-square test was used to check size changes, and p at Results All patients had abdominal discomfort, while 62·5 % had epigastric pain, and 12·5 % had hematemesis. Tumor sizes ranged from 8·4 to 20 cm 2/3 were located in the upper stomach. Five patients (31·3 %) harbored lesions with low risk malignancy, eight (50 %) with moderate risk and three (18·8 %) with high risk. Wedge gastrectomy was the most common operation performed (81·25 %) while partial gastrectomy was carried out in the rest, reporting no recurrence for 6 months. Not determined in group A patients, c-kit status was strongly positive in all members of group B; in two of them treatment was suspended due to poor response. Conclusion Imatinib has an acceptable safety profile and can be considered as a neoadjuvant therapy in GISTs. Until clear guidelines have been developed, we report that a 6 month intake may noticeably increase their resectability potential and improve prognosis.

PWE-110 What is the significance of “diminutive” colonic polyps in patients screened for colon cancer after a positive faecal human haemoglobin test (FHH)?

IntroductionBy definition “diminutive” colonic polyps are ≤5 mm in size. Improvements in optical imaging modalities and image resolution coupled with increased operator awareness have resulted in a higher detection rates...

Febrile neutropenia in hematologic malignancies: Validation of a model to select patients manageable in the outpatient setting safely.

e19641 Background: Febrile neutropenia (FN) is usually treated in an inpatient setting with empiric IV antibiotics. Accurate identification of low-risk hematologic malignancy (HM) pts (highest risk for life-threatening events) appropriate for outpatient management may reduce healthcare costs without impacting outcomes adversely. Prior studies using predictive models to identify low risk FN pts have not been validated in HM pts. Aim: To identify low risk HM pts as candidates for safe outpatient management. Methods: To determine parameters associated with an uncomplicated FN course in HM pts we tested the association between Talcott’s criteria (Talcott et al JCO Oct 2011) and additional candidate risk factors with the development of a medical event (ME) requiring urgent intervention. We conducted a retrospective cohort study of stable HM pts, admitted for FN management. Utilizing Cox regression, we examined the following factors: Talcott criteria, age, insurance status, prophylactic G-CSF/antibiotics, vitals signs and organ function. Results: We identified 97 consecutively admitted pts who met eligibility criteria of whom 27 pts developed a ME during the admission (validated by 2 investigators blinded to exposure status). In univariate analysis, Talcott’s criteria successfully identified pts at low risk for developing a ME (HR .4, p=.04 CI .17-.97). Additionally a preserved DPB (>65 mmHg) was also protective (HR .22 p<.01 CI .11-.51). Talcott’s criteria and DBP remained independent predictors of uncomplicated FN in a multivariate cox regression (AUROC curve=75%). Conclusions: This study provides support for the use of Talcott’s criteria in HM pts. The addition of DBP to Talcott’s model further improves its ability to identify low risk HM pts. Once prospectively validated, this approach may have important clinical and financial implications. [Table: see text]

Mo1032 What is the Significance of “Diminutive” Colonic Polyps in Patients Screened for Colon Cancer After a Positive Faecal Human Haemoglobin Test (FHH)?

Introduction By definition “diminutive” colonic polyps are ≤5 mm in size. Improvements in optical imaging modalities and image resolution coupled with increased operator awareness have resulted in a higher detection rates at colonoscopy. Although such polyps are low risk for malignancy, studies suggest that high grade dysplasia may occur up to a rate of 4% in these polyps. There is an ongoing debate regarding the natural history and prognostic relevance of these polyps including suggestions for non-resection/to resect and discard. Aim To analyse the significance of “Diminutive” colonic polyps in patients screened for colon cancer after a positive Faecal Human Haemoglobin test. Methods Patients referred to a single tertiary institution in South Australia for screening colonoscopy after detection of a positive FHH. All patients referred between 2007 and 2010 were included in this retrospective study. The patients were referred either through the National Bowel Cancer Screening Program (NBCSP) or through GP initiated screening. Polyps were measured after the tissue was placed in formalin (histological size). For each colonoscopy the predetermined aim was to resect all polyps and assess histologically. Results A total of 384 patients had colonoscopy. NBCSP referred (n=173, 45%) and GP initiated FOBT (n=211, 55%). 228 M: 156 F with mean age of 61.8±0.6 yrs, 305 polyps in total. Majority of the polyps (57%, n=173) were ≤5 mm compared with 6–9 mm (23%, n=69; p Conclusion In patients who are positive for FHH the incidence of diminutive polyps is considerable and importantly there is a significant proportion of adenomatous polyps. Based on these findings we believe that diminutive polyps should be resected, histologically evaluated and followed-up appropriately. Competing interests None declared.

Triaging women with ovarian masses for surgery: observational diagnostic study to compare RCOG guidelines with an International Ovarian Tumour Analysis (IOTA) group protocol

To compare guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG) based on the Risk of Malignancy Index (RMI) with a protocol based on logistic regression model LR2 developed by the International Ovarian Tumour Analysis (IOTA) group for triaging women with an ovarian mass as low, moderate, or high risk of malignancy. Observational diagnostic study conducted between 2005 and 2007 at 21 oncology referral centres, referral centres for ultrasonography and general hospitals. In all, 1938 women undergoing surgery for an ovarian mass. RCOG guidelines use the RMI to triage women as low (RMI < 25), moderate (25-250), or high (above >250) risk. The IOTA protocol uses LR2s estimated probability of malignancy (<0.05 indicates low risk, ≥ 0.05 but <0.25 moderate risk, and ≥ 0.25 high risk). Percentages of benign, borderline and invasive tumours classified as low, moderate or high risk. The IOTA and RCOG protocols classified 71.1% and 62.1% of benign tumours as low risk, respectively (difference 9.0; 95% CI 6.2-11.9, P < 0.0001). Of invasive tumours, 88.6% and 73.6% were labelled high risk (difference 15.0; 10.6-19.4, P < 0.0001), and 3.0% and 5.2% were labelled low risk (difference -2.2; -4.6 to 0.2, P = 0.07) respectively by each protocol. Similar results were found after stratification for menopausal status. The IOTA protocol was more accurate for triage than the RCOG protocol. The IOTA protocol would avoid major surgery for more women with benign tumours while still appropriately referring more women with an invasive tumour to a gynaecological oncologist.

Seeking Help From ShadowsThe Author’s Reply

To the Editor The article by Renshaw1 expressed the views that nondiagnostic thyroid fine-needle aspiration should be followed by repeat aspiration and that patients with 2 sequential nondiagnostic aspirations have a very low risk of malignancy. We agree with this view. However, the difficulty arises in the case of cystic thyroid lesions. We are of the view that while doing a repeat aspiration it is better to correlate with ultrasonographic findings and better aspirate from a solid area under guidance. According to Moon et al,2 shape, margin, echogenicity, and presence of calcification are helpful ultrasound criteria for the discrimination of malignant …

Mucocele-like tumor associated with ductal carcinoma in situ diagnosed as mucinous carcinoma by fine-needle aspiration cytology: report of a case

Mucocele-like tumors (MLTs) of the breast are rare, with only 11 cases reported from Japan and 35 cases from other countries. MLTs of the breast were first described by Rosen in 1986. They are believed to be related to atypical ductal hyperplasia, ductal carcinoma, or mucinous carcinoma. It is difficult to diagnose this tumor preoperatively, and especially difficult to differentiate between benign and malignant forms. We report a case of MLT associated with ductal carcinoma in situ, which was initially diagnosed as fibroadenoma by mammography and ultrasonography, and as mucinous carcinoma by fine-needle aspiration cytology. We discuss the characteristic findings of imaging and the appropriate clinical treatment of this tumor. The characteristic image first signals the possibility of this tumor, following which the diagnosis can be confirmed by pathological examination of a fully excised tumor specimen. Breast-conserving surgery is recommended because of the low risk of high-grade malignancy, even when malignancy is confirmed, and lymph node dissection may be avoided.

A randomised controlled trial comparing surgical intervention rates between two protocols for the management of asymptomatic adnexal tumours in postmenopausal women

IntroductionDetection of asymptomatic adnexal tumours in postmenopausal women has increased due to wider use of diagnostic ultrasound and imaging quality improvements. Reliable methods to differentiate between benign and malignant tumours...

Unexpected ovarian malignancy after conservative laparoscopic surgery: five case series in a half decade of experience

To analyse and describe cases of unexpected ovarian malignancy after conservative laparoscopic surgery for an apparent benign ovarian mass at our centre. This retrospective study was performed by collecting data from records of premenopausal women who underwent conservative laparoscopic surgery for benign ovarian mass at Siriraj Hospital over a 5 year period from 2006 to 2010. The rate of unexpected malignancy, histopathological type of the ovarian neoplasm and follow-up after surgery were reviewed. During the study period, 1,161 patients underwent conservative laparoscopic surgery. Of these, five (0.43%) had ovarian malignancy which were diagnosed after reviewing histopathological report postoperatively. The histopathological diagnosis was borderline tumour in two patients, clear cell carcinoma, granulosa cell tumour and mucinous cell adenocarcinoma in the other three patients. All patients are alive after a mean follow-up of 9-60 months with two patients developed recurrence. The main concern for laparoscopic management of ovarian masses is unexpected malignancy. However, with careful patient selection, proper technique and an experienced operator, laparoscopic treatment of ovarian masses is the best approach and should be implemented, with low risk of unexpected malignancy and recurrence.

Spectrum of Risk of Malignancy in Subcategories of ‘Atypia of Undetermined Significance’

Objective: To determine if focal ‘nuclear atypia’ or ‘microfollicular architecture’ portends a higher risk of malignancy than other subcategories of atypia of undetermined significance (AUS) in thyroid fine-needle aspirations (FNAs). Study Design: The frequencies of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories were calculated from 3,956 thyroid FNAs interpreted over a 26-month period at The Johns Hopkins Hospital after adoption of TBSRTC. TBSRTC criteria were applied strictly. The risk of malignancy, specifically for AUS subcategories, was analyzed by cyto-histo correlation. Results: Of the 133 cases diagnosed as AUS, 32% were found to have stageable carcinoma (not incidental microcarcinoma) on resection. When the subset of AUS with ‘nuclear atypia’ (AUS-N) was separated from other AUS cases, 48% (30/62) of them had stageable carcinoma on resection; of the AUS subset with ‘microfollicular architecture’ (AUS-F), 27% (8/30) were malignant on resection. The ‘suspicious for papillary thyroid carcinoma’ (SPTC) group maintained a higher risk of malignancy versus AUS-N (relative risk, RR 1.57; 95% CI 1.23–1.81). Conclusion: The subcategory of ‘nuclear atypia’ within AUS indicates a higher risk of malignancy than other subcategories of AUS but has a lower risk of malignancy than SPTC does. Thus, it is an important distinction with potential clinical implications.

Increased Incidence of Chronic Graft-Versus-Host Disease (GVHD) and No Survival Advantage with Filgrastim-Mobilized Peripheral Blood Stem Cells (PBSC) Compared to Bone Marrow (BM) Transplants From Unrelated Donors: Results of Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Protocol 0201, a Phase III, Prospective, Randomized Trial

Abstract 1▪▪This icon denotes a clinically relevant abstract Background:Randomized trials demonstrated that filgrastim-mobilized PBSC compared to BM from HLA-identical siblings improved engraftment kinetics, increased risks of acute and chronic GVHD, but also decreased relapse and improved survival in patients with high risk leukemia. Retrospective analyses of unrelated donor transplants did not appreciate the same PBSC protective effect. Patients and Methods:The BMT CTN, sponsored by the NHLBI and NCI, conducted a Phase III, randomized, multicenter, trial of unrelated donor PBSC versus BM. The primary objective was to compare two-year survival probabilities in the two study arms using an intent-to-treat analysis. Both patients and donors provided informed consent. Fifty centers in the U.S. and Canada enrolled patients between January, 2004 and September 2009. Median follow up is 36 months (interquartile range 25 – 37 months). Randomization was performed in a 1:1 ratio to either PBSC or BM and stratified by transplant center and disease risk. Of the 278 subjects randomized to BM, 5% had no transplant, and 4.3% crossed over to PBSC; of the 273 randomized to PBSC, 4% had no transplant, and 0.4% crossed over to BM, so subjects on both arms had greater than 90% compliance with the assigned therapy. Patient primary disease (AML, ALL, CML, MDS, CMML, and MF), disease risk, gender, age, race, ethnicity, CMV serology, performance status, comorbidity, organ function, conditioning regimen, GVHD prophylaxis, use of growth factors, and donor characteristics were all well balanced between the two groups. Overall, 90% were adults over age 20, 47% had AML, 28% had high risk disease, 48% were conditioned with cyclophosphamide plus total body irradiation, and 71% received tacrolimus plus methotrexate for GVHD prophylaxis. Results:There were no observed differences in outcomes between the two groups except for a higher incidence of overall chronic GVHD (see Table) and more common chronic extensive GVHD with PBSC (46% vs. 31%). There were no survival differences according to graft sources in planned subset analyses of low and high risk malignancy or in those received HLA-matched or mismatched grafts. Primary causes of death were relapse in 54% vs. 49%, graft failure in 7% vs. 0%, acute or chronic GVHD in 22% vs. 34%, others in 16% vs. 16% of the BM and PBSC arms, respectively.Table 1Outcomes at 2 yearsPBSCBMp-valueOverall survival, intent-to-treat51% (45%-57%)46% (40%-52%)0.25Overall survival, transplanted52% (46%-58%)48% (42%-54%)0.37Disease-free survival, transplanted47% (40%-53%)44% (38%-50%)0.60Relapse28% (22%-34%)28% (23%-34%)0.88Non-relapse mortality26% (20%-31%)27% (22%-33%)0.67ANC > 500 by day 2895% (80%-99%)86% (78%-92%)0.09Acute GVHD II-IV by day 10047% (40%-53%)46% (39%-52%)0.87Acute GVHD III-IV by day 10016% (12%-21%)14% (10%-19%)0.37Any chronic GVHD53% (45%-60%)40% (33%-47%)0.02 Conclusion:This large randomized trial shows that PBSC from unrelated donors is associated with higher rates of chronic GVHD compared to BM, although rates of acute GVHD, relapse, non-relapse mortality and overall survival are similar. Disclosures:Off Label Use: Cyclophosphamide, busulfan, melphalan, fludarabine, anti-thymocyte globulin, irradiation were used to eradicate malignancy. Tacrolimus, cyclosporine, methotrexate were used for GVHD prophylaxis. Westervelt:Novartis: Speakers Bureau.

The practical application of the UK 5-point scoring system for breast imaging: how standardisation of reporting supports the multidisciplinary team

The Breast Imaging Reporting and Data System (BI-RADS) was initiated in the United States in the late 1980s to provide a standardised description of imaging features of breast lesions and to relate them to the underlying pathology and risk of malignancy. Features that were helpful in predicting benign or malignant pathology were chosen, originally for mammography and subsequently for ultrasound [1]. BI-RADS has been used as an education tool and to improve quality across the United States and it is now mandatory to include BI-RADS information in mammography reports. Given the diverse nature of practice in the United States with a spectrum of imaging availability and expertise including large dedicated breast centres and small practices where individual clinicians report relatively small numbers of cases, BI-RADS may have been the essential tool in achieving conformity. There are now 6 categories for each feature: 0, incomplete; 1, negative; 2, benign finding(s); 3, probably benign; 4, suspicious abnormality; 5, highly suggestive of malignancy; and 6, known biopsy-proven malignancy. The fourth category is subdivided into a, b and c. The risk of malignancy for each category is well established [2] and studies evaluating observer variability show fair concordance for features describing categories 1, 2, 3 and 5, although there is interobserver variability for the BI-RADS 4 subcategories [3]. BI-RADS is proven to be of value in the standardisation of reporting and is intended to provide clear guidance on further management; however, it has not been widely adopted in the UK. There are philosophical differences between accepted protocols for investigating breast lesions in the United States and the UK that limit the applications of the BI-RADS in the UK. In particular, lesions at a low risk of malignancy (BI-RADS 3 and 4a) [4] undergo short-term follow-up in the United States but, if palpable, would be subject to biopsy in the UK [5]. The reasons for this are unclear, although when BI-RADS was introduced in the United States some facilities only had mammographic services and limited access to image-guided biopsy (especially core biopsy), which is now more readily available. This may account for the different approach to breast diagnosis together with other considerations, such as reimbursement policies and avoidance of litigation. A 5-point scoring system for mammography, ultrasound and cytology was described in the UK in 1998 [6]. This differed from the BI-RADS as it included pathology results and supported the use of triple assessment by clinical examination, imaging and the needle test to improve sensitivity and specificity in the evaluation of breast lesions. Use of this system became fairly widespread, reinforced by the standards imposed by the National Health Service breast screening programme. The UK 5-point breast imaging scoring system has recently been formalised by Maxwell et al [7] on behalf of the Royal College of Radiologists (RCR) Breast Group. It promotes standardisation of reporting and is easily understood by all members of the multidisciplinary team. However, unlike BI-RADS, at present it does not give the likelihood of malignancy in each category. Therefore the article by Taylor et al [8] in this issue of the British Journal of Radiology is timely. The article describes mammography and ultrasound data from 23 741 assessment episodes to quantify the likelihood of cancer with each of the 5 points on the UK scoring system and compares them with points of equivalent cancer risk on the BI-RADS score. This will provide a benchmark for centres to audit the unit's performance. The positive impact that BI-RADS has had on raising standards and unifying research data cannot be underestimated. It has been extensively researched and validated and it is time now for the RCR Breast Group classification to undergo this rigorous testing. The UK 5-point breast imaging scoring system should be used for communication across the multidisciplinary team with analogous systems for clinical examination, MRI, cytology and histopathology reporting. Any discordance between the clinical scoring systems must be resolved before the management of each case is concluded. The careful development and application of a universally accepted scoring system for breast lesions has played an important role in the diagnosis of breast disease, especially in improving the sensitivity and specificity of diagnosticians and optimising the diagnosis of significant disease while minimising harm by overinvestigation. As with BI-RADS, the UK 5-point breast imaging scoring system will continue to evolve and has the capacity to incorporate emerging techniques and modalities. It provides an example of how the imaging community can collaborate to standardise practice and ultimately improve patient care.

Usefulness of Diagnostic Qualifiers for Thyroid Fine-Needle Aspirations With Atypia of Undetermined Significance

The diagnostic category of atypia of undetermined significance (AUS) in the Bethesda System for reporting the results of thyroid fine-needle aspirations (FNAs) is intended to encompass findings associated with a low risk of malignancy. It is unclear if there are patterns within this evolving, heterogeneous category associated with differing risk of malignancy that might warrant alternative classification or clinical management. Therefore, a retrospective review of 512 AUS FNAs from January 2005 to May 2009 was done. Most malignancies associated with AUS were papillary carcinoma (86/96 [90%]), of which 85% (73/86) were follicular variants. Atypia qualifiers were correlated with the follow-up rate of malignancy. The risk of malignancy for architectural atypia alone was approximately half that observed for cytologic, both cytologic and architectural, or unspecified atypia. Architectural atypia alone was less likely to be papillary carcinoma and more likely to be follicular adenoma. The lower risk of malignancy associated with isolated architectural atypia compared with other patterns of AUS should be considered in clinical decision making and in future management guidelines.

Intermenstrual and post-coital bleeding

Abnormal or unscheduled bleeding from the lower genital tract is common. In some women it can be the first symptom of genital tract malignancy. However in majority of women there is a benign or idiopathic cause. The investigation for the abnormal bleeding is dependent on a number of factors, including age, co-existing medical conditions and cervical smear history. Based on these variables, a gynaecologist will be able to make an assessment of risk of malignancy. The majority of women will have a low risk of malignancy and need not have further investigations. Treatment of abnormal bleeding will depend on the cause, this may be removing the abnormality or hormonal treatment to suppress bleeding. In many women no abnormal cause for the bleeding will be found.

Barrett's Esophagus Carries Lower Risk of Malignancy than Previously Estimated

Barrett's Esophagus Carries Lower Risk of Malignancy than Previously Estimated

Significance of Repeatedly Nondiagnostic Thyroid Fine-Needle Aspirations: Table 1

Nondiagnostic thyroid fine-needle aspirations are associated with a risk of malignancy that can be reduced with repeated aspiration. However, the significance of repeated nondiagnostic aspirates is less well studied. This study assessed the risk of malignancy for repeated nondiagnostic aspirates from a large series of cases using the results of histologic follow-up. From a series of 7,089 aspirates, there were 1,671 nondiagnostic aspirates (23.6%), and 235 of these (14.1%) had histologic follow-up. The risk of malignancy for a single nondiagnostic aspirate was 20.0% (47/235). A total of 51 cases had repeated aspiration. The risk of malignancy for cases with a second nondiagnostic aspirate was 0% (0/23), which was significantly less than for patients with a single nondiagnostic aspirate (20.0%; P = .03). Patients with 2 sequential nondiagnostic thyroid aspirates have a very low risk of malignancy. Cytologists should strive to better convey this risk in their reports.

Management of Isolated Adrenal Lesions in Cancer Patients

Adrenal lesions are commonly identified in patients with extra-adrenal cancer. When lesions are present, it is important to identify if the lesion is a metastasis of the primary cancer or a primary adrenal neoplasm. If primary, the adrenal lesion must be evaluated for hypersecretion and its malignant potential determined for appropriate treatment planning. Recent literature was reviewed that focused on the normal investigation of adrenal lesions including radiographic imaging and hormonal evaluations as well as specific focused therapeutic options available for isolated metastatic adrenal lesions. This review presents a pathway approach in investigating these lesions and also discusses various potential treatment options. A proper investigative workup of an adrenal lesion in a cancer patient is critical for proper management. Isolated adrenal metastatic lesions in the cancer patient should be surgically removed when possible, but other options can be considered. In patients who do not have metastasis from extra-adrenal cancer, the decision for surgical resection is dependent on functionality of the tumor and it's potential for malignancy. Observation plays a key role in those tumors that are nonfunctioning and have a low risk of malignancy.

Risk factors of lung, head and neck, esophageal, and kidney and urinary tract carcinomas after liver transplantation: The effect of smoking withdrawal

Liver transplant recipients have an increased risk of malignancy. Smoking is related to some of the most frequent causes of posttransplant malignancy. The incidence and risk factors for the development of neoplasia related to smoking (head and neck, lung, esophageal, and kidney and urinary tract carcinomas) were studied in 339 liver transplant recipients. Risk factors for the development of smoking-related neoplasia were also studied in 135 patients who had a history of smoking so that it could be determined whether smoking withdrawal was associated with a lower risk of malignancy. After a mean follow-up of 7.5 years, 26 patients were diagnosed with 29 smoking-related malignancies. The 5- and 10-year actuarial rates were 5% and 13%, respectively. In multivariate analysis, smoking and older age were independently associated with a higher risk of malignancy. In the smoker subgroup, the variables related to a higher risk of malignancy were active smoking and older age. In conclusion, smoking withdrawal after liver transplantation may have a protective effect against the development of neoplasia.

Effect of six months neoadjuvant imatinib on resectability potential of gastric stromal tumors in Egyptian patients.

151 Background: Though recurrence is high, local excision is the preferred approach for dealing with gastric stromal tumors. Achieving negative margins is mandatory, sometimes requiring subtotal gastrectomy. Adjuvant imatinib is essential for advanced cases and prolonging survival; however, there is not enough data to recommend its use before surgery to increase resectability. The current study aims at investigating this concept in Egyptian patients. Methods: The study included 16 patients (13 males, 3 females, mean age 60 years) presenting with gastrointestinal stromal tumors (GISTs) who were candidates for emergency (n = 3) or elective (n = 13) surgery. Investigations included endoscopy (+ biopsy), sonography, and computed tomography (CT). Patients were enrolled in two groups: A (n = 6: projected to planned surgery) and B (n = 7: harboring c-kit+ tumors). Each B patient received imatinib (400 mg/day) for 6 months before surgery. Clinical and radiological evaluation was at day 100. The Chi-square test was used to check size changes, and p = &lt;0.02535 was considered significant. Results: All patients had abdominal discomfort, while 62.5% had epigastric pain, and 12.5% had hematemesis. Tumor sizes ranged from 8.4 to 20 cm; 2/3 were located in the upper stomach. Five patients (31.3%) harbored lesions with low risk malignancy, eight (50%) with moderate risk and three (18.8%) with high risk. Wedge gastrectomy was the most common operation performed (81.25%) while partial gastrectomy was carried out in the rest, reporting no recurrence for 6 months. Not determined in group A patients, c-kit status was strongly positive in all members of group B; in two of them treatment was suspended due to poor response. Conclusions: Imatinib has an acceptable safety profile and can be considered as a neoadjuvant therapy in GISTs. Until clear guidelines have been developed, we report that a 6-month intake may noticeably increase their resectability potential and improve prognosis. No significant financial relationships to disclose.

Role of 18F-fluoro-2-deoxyglucose Positron Emission Tomography in Gastric GIST: Predicting Malignant Potential Pre-operatively

PurposeIt is difficult to obtain biopsies from gastrointestinal stromal tumors (GISTs) prior to surgery because GISTs are submucoal tumors, despite being the most common nonepithelial neoplasms of the gastrointestinal tract. Unlike anatomic imaging techniques, PET-CT, which is a molecular imaging tool, can be a useful technique for assessing tumor activity and predicting the malignant potential of certain tumors. Thus, we aimed to evaluate the usefulness of PET-CT as a pre-operative prognostic factor for GISTs by analyzing the correlation between the existing post-operative prognostic factors and the maximum SUV uptake (SUVmax) of pre-operative 18F-fluoro-2-deoxyglucose (FDG) PET-CT.Materials and MethodsThe study was conducted on 26 patients who were diagnosed with gastric GISTs and underwent surgery after being examined with pre-operative FDG PET-CT. An analysis of the correlation bewteen (i) NIH risk classfication and the Ki-67 proliferation index, which are post-operative prognostic factors, and (ii) the SUVmax of PET-CT, which is a pre-operative prognostic factor, was performed.ResultsThere were significant correlations between (i) SUVmax and (ii) Ki-67 index, tumor size, mitotic count, and NIH risk group (r=0.854, 0.888, 0.791, and 0.756, respectively). The optimal cut-off value for SUVmax was 3.94 between "low-risk malignancy" and "high-risk malignancy" groups. The sensitivity and specificity of SUVmax for predicting the risk of malignancy were 85.7% and 94.7%, respectively.ConclusionsThe SUVmax of PET-CT is associated with Ki-67 index, tumor size, mitotic count, and NIH classification. Therefore, it is believed that PET-CT is a relatively safe, non-invasive diagnostic tool for assessing malignant potential pre-operatively.