Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS

AIM： To evaluate the ultrasonography （EUS） features of gastric gastrointestinal stromal tumors （GISTs） as compared with gastric leiomyomas and then to determine the EUS features that could predict malignant GISTs. METHODS： We evaluated the endoscopic EUS features in 53 patients with gastric mesenchymal tumors confirmed by histopathologic diagnosis. The GISTs were classified into benign and malignant groups according to the histological risk classification. RESULTS： Immunohistochemical analyses demonstrated 7 leiomyomas and 46 GISTs. Inhomogenicity, hyperechogenic spots, a marginal halo and higher echogenicity as compared with the surrounding muscle layer appeared more frequently in the GISTs than in the leiomyomas （P 〈 0.05）. The presence of at least two of these four features had a sensitivity of 89.1% and a specificity of 85.7% for predicting GISTs. Except for tumor size and irregularity of the border, most of the EUS features were not helpful for predicting the malignant potential of GISTs. On multivariate analysis, only the maximal diameter of the GISTs was an independent predictor. The optimal size for predicting malignant GISTs was 35 mm. The sensitivity and specificity using this value were 92.3% and 78.8%, respectively. CONCLUSION： EUS may help to differentiate gastric GISTs from gastric leiomyomas. Once GISTs are suspected, surgery should be considered if the size is greater than 3.5 cm.