Original article Clinical endoscopy| Volume 69, ISSUE 6, P1039-1044.e1, May 2009

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Diagnosis and management of GI stromal tumors by EUS-FNA: a survey of opinions and practices of endosonographers


      There is no consensus regarding the best management strategy for diagnosing and treating GI stromal tumors (GISTs).


      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.


      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.


      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.


      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.


      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.


      AGA (American Gastroenterological Association), ASGE (American Society for Gastrointestinal Endoscopy), GIST (GI stromal cell tumor), SIG (special interest group)
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        • Raut C.P.
        • Morgan K.A.
        • Ashley S.W.
        Current issues in gastrointestinal stromal tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease.
        Curr Opin Gastroenterol. 2007; 23: 149-158
        • Miettinen M.
        • Sobin L.H.
        • Sarlomo-Rikala M.
        Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117 (KIT).
        Mod Pathol. 2000; 13: 1134-1142
        • Nickl N.
        Endoscopic approach to gastrointestinal stromal tumors.
        Gastrointest Endosc Clin North Am. 2005; 15: 455-466
        • Rubin B.P.
        • Heinrich M.C.
        • Corless C.
        Gastrointestinal stromal tumour.
        Lancet. 2007; 370: 1731-1741
        • Ando N.
        • Goto H.
        • Niwa Y.
        • et al.
        The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis.
        Gastrointest Endosc. 2002; 55: 37-43
        • Hunt G.C.
        • Rader A.E.
        • Faigel D.O.
        A comparison of EUS features between CD-117 positive GI stromal tumors and CD-117 negative GI spindle ell tumors.
        Gastrointest Endosc. 2003; 57: 469-474
        • Hwang J.H.
        • Kimmey M.B.
        The incidental upper gastrointestinal subepithelial mass.
        Gastroenterology. 2004; 126: 301-307
        • Fu K.
        • Eloubeidi M.A.
        • Jhala N.C.
        • et al.
        Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy—a potential pitfall.
        Ann Diagn Pathol. 2002; 6: 294-301
        • Gu M.
        • Ghafari S.
        • Nguyen P.T.
        • et al.
        Cytologic diagnosis of gastrointestinal stromal tumors of the stomach by endoscopic ultrasound-guided fine-needle aspiration biopsy: cytomorphologic and immunohistochemical study of 12 cases.
        Diagn Cytopathol. 2001; 25: 343-350
        • Kwon M.S.
        • Koh J.S.
        • Lee S.S.
        • et al.
        Fine needle aspiration cytology (FNAC) of gastrointestinal stromal tumor: an emphasis on diagnostic role of FNAC, cell block, and immnohistochemistry.
        J Korean Med Sci. 2002; 17: 353-359
        • Matsui M.
        • Goto H.
        • Niwa Y.
        • et al.
        Preliminary results of fine needle aspiration biopsy histology in upper gastrointestinal submucosal tumors.
        Endoscopy. 1998; 30: 750-755
        • Rader A.E.
        • Avery A.
        • Wait C.L.
        • et al.
        Fine-needle aspiration biopsy diagnosis of gastrointestinal stromal tumors using morphology, immunohistochemistry, and mutational analysis of c-kit.
        Cancer. 2001; 93: 269-275
        • Miettinen M.
        • Majidi M.
        • Lasota J.
        Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review.
        Eur J Cancer. 2002; 38: S39-S51
        • Polkowski M.
        Endoscopic ultrasound and endoscopic ultrasound–guided fine-needle biopsy for the diagnosis of malignant submucosal tumors.
        Endoscopy. 2005; 37: 635-645
        • Fletcher C.D.
        • Berman J.J.
        • Corless C.
        • et al.
        Diagnosis of gastrointestinal stromal tumors: a consensus approach.
        Hum Pathol. 2002; 33: 459-465
        • Chak A.
        • Canto M.I.
        • Rosch T.
        • et al.
        Endosonographic differentiation of benign and malignant stromal cell tumors.
        Gastrointest Endosc. 1997; 45: 468-473
        • DeMatteo R.P.
        • Lewis J.J.
        • Leung D.
        • et al.
        Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival.
        Ann Surg. 2000; 231: 51-58
        • Franquemont D.W.
        Differentiation and risk assessment of gastrointestinal stromal tumors.
        Am J Clin Pathol. 1995; 103: 41-47
        • Palazzo L.
        • Landi B.
        • Cellier C.
        • et al.
        Endosonographic features predictive of benign and malignant gastrointestinal stromal tumours.
        Gut. 2000; 46: 88-92
        • Hwang J.H.
        • Rulyak S.D.
        • Kimmey M.B.
        • et al.
        American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses.
        Gastroenterology. 2006; 130: 2217-2228
        • American Gastroenterological Association Institute
        American Gastroenterological Association Institute medical position statement of the management of gastric subepithelial masses.
        Gastroenterology. 2006; 130: 2215-2216
        • Davila R.E.
        • Faigel D.O.
        GI stromal tumors.
        Gastrointest Endosc. 2003; 58: 80-88
        • Sarlomo-Rikala M.
        • Kovatich A.J.
        • Barusevicius A.
        • et al.
        CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34.
        Mod Pathol. 1998; 11: 728-734
        • Okai T.
        • Minamoto T.
        • Ohtsubo K.
        • et al.
        Endosonographic evaluation of c-kit-positive gastrointestinal stromal tumor.
        Abdom Imaging. 2003; 28: 301-307

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