Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors

Overview

Journal Clin Endosc

Date 2019 Jul 24

PMID 31331161

Citations 6

Authors

Takashi Tamura

Masayuki Kitano

Affiliations

Soon will be listed here.

Abstract

Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficult to distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosing subepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguish between tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyperenhancement pattern in gastrointestinal stromal tumors (sensitivity, 78%-100%; specificity, 60%-100%; accuracy, 60%-100%) and hypoenhancement pattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimate the malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels inside the tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection of vascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated by evaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrastenhanced ultrasound. However, there will be subjective-bias and the results depends on the performer's skill.

Citing Articles

Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management.

Varanese M, Spadaccini M, Facciorusso A, Franchellucci G, Colombo M, Andreozzi M Medicina (Kaunas). 2024; 60(10).

PMID: 39459482 PMC: 11509196. DOI: 10.3390/medicina60101695.

The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer.

Cheng X, Xia J, Xu Q, Gui H Open Med (Wars). 2023; 18(1):20230805.

PMID: 38025541 PMC: 10656759. DOI: 10.1515/med-2023-0805.

EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?.

Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C Diagnostics (Basel). 2023; 13(13).

PMID: 37443568 PMC: 10340322. DOI: 10.3390/diagnostics13132176.

Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours.

Pallio S, Crino S, Maida M, Sinagra E, Tripodi V, Facciorusso A Cancers (Basel). 2023; 15(4).

PMID: 36831627 PMC: 9954263. DOI: 10.3390/cancers15041285.

Contrast Harmonic-Enhanced Endoscopic Ultrasound (EUS) Is the Perfect Companion of EUS-Guided Tumor Ablation.

Marocchi G, Lisotti A, Fusaroli P Gut Liver. 2020; 14(5):669-670.

PMID: 32773387 PMC: 7492498. DOI: 10.5009/gnl20077.

References

Nishida T, Hirota S . Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol. 2000; 15(4):1293-301. DOI: 10.14670/HH-15.1293. View

Desser T, Jeffrey R . Tissue harmonic imaging techniques: physical principles and clinical applications. Semin Ultrasound CT MR. 2001; 22(1):1-10. DOI: 10.1016/s0887-2171(01)90014-9. View

Van Den Abbeele A, Badawi R . Use of positron emission tomography in oncology and its potential role to assess response to imatinib mesylate therapy in gastrointestinal stromal tumors (GISTs). Eur J Cancer. 2003; 38 Suppl 5:S60-5. DOI: 10.1016/s0959-8049(02)80604-9. View

Takahashi R, Tanaka S, Kitadai Y, Sumii M, Yoshihara M, Haruma K . Expression of vascular endothelial growth factor and angiogenesis in gastrointestinal stromal tumor of the stomach. Oncology. 2003; 64(3):266-74. DOI: 10.1159/000069316. View

Okai T, Minamoto T, Ohtsubo K, Minato H, Kurumaya H, Oda Y . Endosonographic evaluation of c-kit-positive gastrointestinal stromal tumor. Abdom Imaging. 2003; 28(3):301-7. DOI: 10.1007/s00261-002-0055-x. View

Takahashi R, Tanaka S, Hiyama T, Ito M, Kitadai Y, Sumii M . Hypoxia-inducible factor-1alpha expression and angiogenesis in gastrointestinal stromal tumor of the stomach. Oncol Rep. 2003; 10(4):797-802. View

Fukuta N, Kitano M, Maekawa K, Chikugo T, Kudo M . Estimation of the malignant potential of gastrointestinal stromal tumors: the value of contrast-enhanced coded phase-inversion harmonics US. J Gastroenterol. 2005; 40(3):247-55. DOI: 10.1007/s00535-004-1531-6. View

Chen W, Huang C, Wu M, Yang S, Su Y, Chai C . Hypoxia-inducible factor-1alpha is associated with risk of aggressive behavior and tumor angiogenesis in gastrointestinal stromal tumor. Jpn J Clin Oncol. 2005; 35(4):207-13. DOI: 10.1093/jjco/hyi067. View

Hwang J, Rulyak S, Kimmey M . American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006; 130(7):2217-28. DOI: 10.1053/j.gastro.2006.04.033. View

10.

Choi H, Charnsangavej C, Faria S, Macapinlac H, Burgess M, Patel S . Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol. 2007; 25(13):1753-9. DOI: 10.1200/JCO.2006.07.3049. View

11.

Kollmann C . New sonographic techniques for harmonic imaging--underlying physical principles. Eur J Radiol. 2007; 64(2):164-72. DOI: 10.1016/j.ejrad.2007.07.024. View

12.

Kitano M, Sakamoto H, Matsui U, Ito Y, Maekawa K, von Schrenck T . A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc. 2007; 67(1):141-50. DOI: 10.1016/j.gie.2007.07.045. View

13.

Sanchez M, Varadarajulu S, Napoleon B . EUS contrast agents: what is available, how do they work, and are they effective?. Gastrointest Endosc. 2009; 69(2 Suppl):S71-7. DOI: 10.1016/j.gie.2008.12.004. View

14.

Lassau N, Chami L, Koscielny S, Chebil M, Massard C, Benatsou B . Quantitative functional imaging by dynamic contrast enhanced ultrasonography (DCE-US) in GIST patients treated with masatinib. Invest New Drugs. 2010; 30(2):765-71. DOI: 10.1007/s10637-010-9592-2. View

15.

Sakamoto H, Kitano M, Matsui S, Kamata K, Komaki T, Imai H . Estimation of malignant potential of GI stromal tumors by contrast-enhanced harmonic EUS (with videos). Gastrointest Endosc. 2011; 73(2):227-37. DOI: 10.1016/j.gie.2010.10.011. View

16.

Saftoiu A, Dietrich C, Vilmann P . Contrast-enhanced harmonic endoscopic ultrasound. Endoscopy. 2012; 44(6):612-7. DOI: 10.1055/s-0032-1308909. View

17.

Kannengiesser K, Mahlke R, Petersen F, Peters A, Ross M, Kucharzik T . Contrast-enhanced harmonic endoscopic ultrasound is able to discriminate benign submucosal lesions from gastrointestinal stromal tumors. Scand J Gastroenterol. 2012; 47(12):1515-20. DOI: 10.3109/00365521.2012.729082. View

18.

Seo S, Hong S, Han J, Choi M, Song J, Kim H . Accuracy of a scoring system for the differential diagnosis of common gastric subepithelial tumors based on endoscopic ultrasonography. J Dig Dis. 2013; 14(12):647-53. DOI: 10.1111/1751-2980.12099. View

19.

Yamashita Y, Kato J, Ueda K, Nakamura Y, Abe H, Tamura T . Contrast-enhanced endoscopic ultrasonography can predict a higher malignant potential of gastrointestinal stromal tumors by visualizing large newly formed vessels. J Clin Ultrasound. 2014; 43(2):89-97. DOI: 10.1002/jcu.22195. View

20.

Min Y, Park H, Min B, Choi D, Kim K, Kim S . Preoperative predictive factors for gastrointestinal stromal tumors: analysis of 375 surgically resected gastric subepithelial tumors. J Gastrointest Surg. 2014; 19(4):631-8. DOI: 10.1007/s11605-014-2708-9. View