Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Course of Small Subepithelial Tumors of the Small Bowel Detected on CT

전산화단층촬영에서 확인된 소장의 작은 상피하종양의 임상 경과 연구

  • Seohyun Kim (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Seung Joon Choi (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Su Joa Ahn (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • So Hyun Park (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Young Sup Shim (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Jeong Ho Kim (Department of Radiology, Gil Medical Center, Gachon University College of Medicine)
  • 김서현 (가천대학교 의과대학 길병원 영상의학과) ;
  • 최승준 (가천대학교 의과대학 길병원 영상의학과) ;
  • 안수좌 (가천대학교 의과대학 길병원 영상의학과) ;
  • 박소현 (가천대학교 의과대학 길병원 영상의학과) ;
  • 심영섭 (가천대학교 의과대학 길병원 영상의학과) ;
  • 김정호 (가천대학교 의과대학 길병원 영상의학과)
  • Received : 2021.03.23
  • Accepted : 2021.09.04
  • Published : 2022.05.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose This study aimed to evaluate the natural growth of subepithelial tumors of the small bowel detected on CT. Materials and Methods Consecutive patients who were suspected of having subepithelial tumors of the small bowel between January 2005 and December 2020 were reviewed. Eligible patients with suspected small (< 30 mm) subepithelial tumors on at least two CT evaluations were included in the analysis. The patients' data on demographic characteristics, tumoral characteristics, and tumoral size changes during the follow-up were collected. Results This study included 64 patients with suspected small subepithelial tumors (n = 64) of the small bowel. After a median follow-up of 15.8 months, the diameter and volume growth rates were 0.02 mm/month and 1.5 mm3/month, respectively. A significant correlation was observed between the initial size and the growth rate of the small bowel subepithelial tumors. The group of large-sized tumors (initial diameter ≥ 10 mm) tended to show lobulated contours, heterogeneous enhancement, and necrotic changes more frequently than the group of small-sized tumors (initial diameter < 10 mm). Conclusion Small bowel subepithelial tumors measuring less than 10 mm grew more slowly than those measuring 10-30 mm.

목적 이 연구의 목적은 CT에서 확인된 소장의 작은 상피하종양의 임상 경과를 밝히는 것이다. 대상과 방법 2005년 1월부터 2020년 12월까지 전산화단층촬영에서 소장의 상피하종양이 의심되는 환자들을 분석했다. 최소 2개월 간격을 두고 시행한 2차례 이상 전산화단층촬영에서 30 mm 미만의 소장 상피하종양이 보인 환자를 연구에 포함시켰다. 저자들은 환자의 임상정보, 병변의 소견 및 추적 관찰 영상에서의 변화를 기록하였다. 결과 총 64명의 환자에서 64개의 소장 상피하종양이 분석에 포함되었다. 추적관찰 기간의 중앙값인 15.8개월 동안 병변의 길이 변화와 부피 변화는 각각 0.02 mm/월, 1.5 mm3/월이었다. 소장 상피하종양의 초기 병변의 크기와 크기 변화속도는 통계적으로 유의한 연관성을 보였다. 추가적으로 10 mm 이상의 그룹은 10 mm 미만의 그룹보다 lobulated contour, 불균질한 조영증강, 괴사를 보이는 경우가 더 많았다. 결론 10 mm 미만의 소장 상피하종양이 10 mm 이상 30 mm 미만의 종괴보다 천천히 자란다.

Keywords

References

  1. Hedenbro JL, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc 1991;5:20-23 https://doi.org/10.1007/BF00591381
  2. Papanikolaou IS, Triantafyllou K, Kourikou A, Rosch T. Endoscopic ultrasonography for gastric submucosal lesions. World J Gastrointest Endosc 2011;3:86-94 https://doi.org/10.4253/wjge.v3.i5.86
  3. Kawanowa K, Sakuma Y, Sakurai S, Hishima T, Iwasaki Y, Saito K, et al. High incidence of microscopic gastrointestinal stromal tumors in the stomach. Hum Pathol 2006;37:1527-1535 https://doi.org/10.1016/j.humpath.2006.07.002
  4. Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavsson B, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer 2005;103:821-829 https://doi.org/10.1002/cncr.20862
  5. Patel N, Benipal B. Incidence of gastrointestinal stromal tumors in the United States from 2001-2015: a United States cancer statistics analysis of 50 states. Cureus 2019;11:e4120
  6. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 2010;8 Suppl 2:S1-41; quiz S42-S44 https://doi.org/10.6004/jnccn.2010.0116
  7. Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, et al. Gastrointestinal stromal tumours: ESMOEURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29:iv267
  8. Cho JW; Korean ESD Study Group. Current guidelines in the management of upper gastrointestinal subepithelial tumors. Clin Endosc 2016;49:235-240 https://doi.org/10.5946/ce.2015.096
  9. Nishida T. Asian consensus guidelines for gastrointestinal stromal tumor: what is the same and what is different from global guidelines. Transl Gastroenterol Hepatol 2018;3:11
  10. Kim MY, Jung HY, Choi KD, Song HJ, Lee JH, Kim DH, et al. Natural history of asymptomatic small gastric subepithelial tumors. J Clin Gastroenterol 2011;45:330-336 https://doi.org/10.1097/MCG.0b013e318206474e
  11. Ye LS, Li Y, Liu W, Yao MH, Khan N, Hu B. Clinical course of suspected small gastrointestinal stromal tumors in the stomach. World J Gastrointest Surg 2020;12:171-177 https://doi.org/10.4240/wjgs.v12.i4.171
  12. Schwartz M. A biomathematical approach to clinical tumor growth. Cancer 1961;14:1272-1294 https://doi.org/10.1002/1097-0142(196111/12)14:6<1272::AID-CNCR2820140618>3.0.CO;2-H
  13. Choi JW, Choi D, Kim KM, Sohn TS, Lee JH, Kim HJ, et al. Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT. Korean J Radiol 2012;13:425-433 https://doi.org/10.3348/kjr.2012.13.4.425
  14. Choi YR, Kim SH, Kim SA, Shin CI, Kim HJ, Kim SH, et al. Differentiation of large (≥ 5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: radiologists' performance using CT. Eur J Radiol 2014;83:250-260 https://doi.org/10.1016/j.ejrad.2013.10.028
  15. Cai PQ, Lv XF, Tian L, Luo ZP, Mitteer RA Jr, Fan Y, et al. CT characterization of duodenal gastrointestinal stromal tumors. AJR Am J Roentgenol 2015;204:988-993 https://doi.org/10.2214/AJR.14.12870
  16. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459-465 https://doi.org/10.1053/hupa.2002.123545
  17. Tio TL, Tytgat GN, den Hartog Jager FC. Endoscopic ultrasonography for the evaluation of smooth muscle tumors in the upper gastrointestinal tract: an experience with 42 cases. Gastrointest Endosc 1990;36:342-350 https://doi.org/10.1016/S0016-5107(90)71061-9
  18. Lim YJ, Son HJ, Lee JS, Byun YH, Suh HJ, Rhee PL, et al. Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy. World J Gastroenterol 2010;16:439-444 https://doi.org/10.3748/wjg.v16.i4.439
  19. Melzer E, Fidder H. The natural course of upper gastrointestinal submucosal tumors: an endoscopic ultrasound survey. Isr Med Assoc J 2000;2:430-432
  20. Nishida T, Kawai N, Yamaguchi S, Nishida Y. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 2013;25:479-489 https://doi.org/10.1111/den.12149
  21. Landi B, Blay JY, Bonvalot S, Brasseur M, Coindre JM, Emile JF, et al. Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis 2019;51:1223-1231 https://doi.org/10.1016/j.dld.2019.07.006
  22. Hwang JH, Rulyak SD, Kimmey MB; American Gastroenterological Association Institute. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 2006;130:2217-2228 https://doi.org/10.1053/j.gastro.2006.04.033
  23. Song JH, Kim SG, Chung SJ, Kang HY, Yang SY, Kim YS. Risk of progression for incidental small subepithelial tumors in the upper gastrointestinal tract. Endoscopy 2015;47:675-679 https://doi.org/10.1055/s-0034-1391967
  24. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23:70-83 https://doi.org/10.1053/j.semdp.2006.09.001
  25. Miettinen M, Makhlouf H, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up. Am J Surg Pathol 2006;30:477-489 https://doi.org/10.1097/00000478-200604000-00008
  26. Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, et al. Asian consensus guidelines for the diagnosis and management of gastrointestinal stromal tumor. Cancer Res Treat 2016;48:1155-1166 https://doi.org/10.4143/crt.2016.187
  27. Dematteo RP, Gold JS, Saran L, Gonen M, Liau KH, Maki RG, et al. Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 2008;112:608-615 https://doi.org/10.1002/cncr.23199
  28. Sokhandon F, Al-Katib S, Bahoura L, Copelan A, George D, Scola D. Multidetector CT enterography of focal small bowel lesions: a radiological-pathological correlation. Abdom Radiol (NY) 2017;42:1319-1341 https://doi.org/10.1007/s00261-016-1015-1
  29. Paulsen SR, Huprich JE, Fletcher JG, Booya F, Young BM, Fidler JL, et al. CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 2006;26:641-657; discussion 657-662 https://doi.org/10.1148/radiographics.26.3.0260657
  30. Elsayes KM, Al-Hawary MM, Jagdish J, Ganesh HS, Platt JF. CT enterography: principles, trends, and interpretation of findings. Radiographics 2010;30:1955-1970  https://doi.org/10.1148/rg.307105052