Xu H, Liu JR, Gao BJ, Peng L, Han ZQ, Zhang RX. Ultrasound elastography for the differential diagnosis of benign and malignant gastrointestinal stromal tumors. World J Gastrointest Surg 2025; 17(6): 103674 [DOI: 10.4240/wjgs.v17.i6.103674]
Corresponding Author of This Article
Hao Xu, Bachelor of Medicine, Attending Physician, Department of Ultrasound Diagnosis, Bethune International Peace Hospital, No. 398 Zhongshan West Road, Qiaoxi District, Shijiazhuang 050000, Hebei Province, China. xh330029nb@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hao Xu, Jiao-Ran Liu, Long Peng, Zhi-Qin Han, Rong-Xin Zhang, Department of Ultrasound Diagnosis, Bethune International Peace Hospital, Shijiazhuang 050000, Hebei Province, China
Bo-Jian Gao, Department of Otolaryngology Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang 050000, Hebei Province, China
Author contributions: Xu H and Liu JR conceived the study; Peng L participated in the data collection; Han ZQ and Xu H drafted the initial version of the manuscript; Zhang RX and Han ZQ contributed to the formal analysis of this study; Liu JR conducted the research, methodology, and visualization; Xu H and Liu JR validated the study; Xu H, Liu JR, Gao BJ, Peng L, Han ZQ, and Zhang RX participated in the study and jointly reviewed and edited the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Bethune International Peace Hospital in Hebei Province (No. BIPH-LL-2021-011).
Clinical trial registration statement: This study is registered at the Clinical Registry. https://www.researchregistry.com (Researchregistry11143).
Informed consent statement: The study was conducted with the consent of patients and their guardians who signed informed consent forms.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No data available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Xu, Bachelor of Medicine, Attending Physician, Department of Ultrasound Diagnosis, Bethune International Peace Hospital, No. 398 Zhongshan West Road, Qiaoxi District, Shijiazhuang 050000, Hebei Province, China. xh330029nb@126.com
Received: March 7, 2025 Revised: March 31, 2025 Accepted: May 6, 2025 Published online: June 27, 2025 Processing time: 84 Days and 3.8 Hours
Abstract
BACKGROUND
Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors (GISTs) poses a challenge. Ultrasound elastography has emerged as a promising diagnostic tool; however, further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.
AIM
To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.
METHODS
This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023. All tumors underwent conventional ultrasound examination, strain elastography (SE), and shear-wave elastography (SWE) before surgical resection. The study evaluated elastographic parameters such as strain ratio, elastographic patterns, mean elastic modulus, and heterogeneity index. Diagnostic performance was evaluated using receiver operating characteristic curve analysis, with histopathological diagnosis as the reference standard.
RESULTS
Of the 103 GISTs, 45 (43.7%) were benign and 58 (56.3%) were malignant based on modified National Institutes of Health criteria. Malignant GISTs exhibited significantly higher strain ratios (4.82 ± 1.73 vs 2.31 ± 0.89; P < 0.001) and mean elastic modulus values (45.6 ± 15.8 kPa vs 21.3 ± 8.4 kPa; P < 0.001) than benign tumors. The optimal cutoff values were 3.45 for the strain ratio (sensitivity: 84.5%, specificity: 86.7%) and 32.5 kPa for the mean elastic modulus (sensitivity: 87.9%, specificity: 88.9%). The areas under the curve were 0.892 and 0.918, respectively. Interobserver agreement was excellent for both SE [intraclass correlation coefficient (ICC) = 0.88] and SWE (ICC range: 0.85-0.93) measurements.
CONCLUSION
Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs. Combining SE and SWE provides complementary parameters for preoperative risk stratification.
Core Tip: Ultrasound elastography, combining strain elastography and shear-wave elastography, provides excellent diagnostic precision in distinguishing between benign and malignant gastrointestinal stromal tumors (GISTs). A study involving 103 GISTs revealed that malignant tumors displayed notably elevated strain ratios and average elastic moduli. The optimal thresholds for strain ratio (3.45) and mean elastic modulus (32.5 kPa) exhibited high sensitivity and specificity. This noninvasive imaging approach can facilitate preoperative risk assessment and enhance the diagnostic evaluation of GISTs.
