Background
There is no consensus regarding the best management strategy for diagnosing and treating
GI stromal tumors (GISTs).
Objective
Our purpose was to examine the practice patterns of endosonographers in diagnosing
and managing GISTs, particularly features of GISTs suggestive of malignancy, features
that prompt surgical referral, and surveillance patterns.
Design
An invitation to complete an online survey was e-mailed to all 413 members of the
American Society for Gastrointestinal Endoscopy EUS Special Interest Group.
Results
A total of 134 (32%) members responded; 59% of respondents use EUS features combined
with FNA findings to diagnose GIST, and 89% consider a c-kit–positive stain on FNA most suggestive of GIST. However, 60% would diagnose GIST when
cytologic samples are insufficient for diagnosis, and 40% would diagnose GIST if cytologic
samples are sufficient but c-kit is negative. A total of 92% use size as the main criterion to distinguish benign
from malignant GISTs, and 90% refer lesions >5 cm for surgery. For lesions not resected,
70% survey annually, 19% less than annually, 10% more than annually, and 1% do not
survey.
Limitations
The opinions of the respondents do not necessarily reflect the opinions and practices
of endosonographers nationwide. There are inherent limitations to an online multiple-choice
survey, including low response rates.
Conclusions
There are substantial practice variations in diagnosing, resecting, and surveying
GISTs. A majority of our survey respondents have made the diagnosis of GIST without
FNA confirmation. Size >5 cm is the feature used most to predict malignancy and to
prompt surgical referral. Surveillance practices for unresected GISTs are variable.
Evidence is needed to establish practice guidelines in this area.
Abbreviations:
AGA (American Gastroenterological Association), ASGE (American Society for Gastrointestinal Endoscopy), GIST (GI stromal cell tumor), SIG (special interest group)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
July 22,
2008
Received:
February 13,
2008
St Louis, Missouri, USAFootnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you want to chat with an author of this article, you may contact her at [email protected]
Identification
Copyright
© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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- Diagnosis and management of GI stromal tumors by EUS-guided FNAGastrointestinal EndoscopyVol. 71Issue 6
