Gastrointestinal stromal tumor最新文献

{"title":"Could artificial intelligence replace fine-needle aspiration in endoscopic ultrasound?","authors":"S. Jiang, N. Parsa, M. Byrne","doi":"10.21037/gist-22-11","DOIUrl":"https://doi.org/10.21037/gist-22-11","url":null,"abstract":"© Gastrointestinal Stromal Tumor. All rights reserved. Gastrointest Stromal Tumor 2022 | https://dx.doi.org/10.21037/gist-22-11 The recent application of artificial intelligence (AI) in the field of gastroenterology has shown promising results in the diagnosis and management of digestive diseases (1-3). Solutions such as AI-powered detection and diagnosis systems are now commercially available for colorectal polyps (4). The backbone of AI systems for image classification is the convolutional neural network (CNN), a deep-learning algorithm that conducts multi-level image analysis through pattern recognition, and improves its own diagnostic ability by training with large datasets (5,6). With the ability to integrate pixel-level data, CNN is able to aid endoscopists in the rapid interpretation of seemingly ambiguous visual data. One such area of diagnostic dilemma is the evaluation of gastric subepithelial lesions (SELs). While endoscopic ultrasound (EUS) is the most accurate imaging modality, there are no definitive EUS features to differentiate gastrointestinal stromal tumors (GISTs) from the commonly encountered gastrointestinal leiomyomas (GILs) (7-9). Misdiagnosis of GISTs and GILs are thought to comprise the majority of incorrect EUS diagnoses (9). Given the malignant potential of GISTs, it is crucial to accurately diagnose these lesions and to differentiate them from GILs, which are benign. The current standard is to differentiate these two by obtaining tissue samples with fine-needle aspiration or biopsy (EUS-FNA/B). However, FNA/B is invasive and is reported to have a lower diagnostic rate for SELs smaller than 20 mm (9,10). In this issue of Endoscopy, Yang et al. report the result of their AI-powered EUS model for differentiation between GISTs and GILs (11). Using a CNN for image recognition, the AI model was trained, validated, and evaluated on a total of 10,439 EUS images from 752 patients with histologically confirmed GISTs and GILs from four endoscopic centers, collected in aggregate from 2013 to 2020. They report a significantly higher diagnostic accuracy with the AI model compared with the expert endo-sonographer (94.0% vs. 70.2%, P value <0.001). More importantly, in the prospective evaluation of 508 consecutive patients with SELs, of whom 132 underwent histologic confirmation, the diagnostic accuracy remained significantly higher with the AI-powered EUS compared with the expert endosonographer (78.8% vs. 69.7%, P value =0.01). When examining only cases of histologically-confirmed GISTS or GILs, AI-joint diagnosis also had significantly higher accuracy, specificity, and PPV at 92.2%, 95.1%, and 94.1%, respectively, compared to individual diagnosis alone at 76.6% (P value =0.01), 65.9% (P value =0.002), and 69.6% (P value <0.01), respectively. The sensitivity and NPV of AI-joint diagnosis were similar to individual diagnosis. These are promising results in applying deep learning to real-time EUS to distinguish between GISTs and GILs.","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43598835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jejunal gastrointestinal stromal tumor (GIST): a case report presenting as life threatening emergency","authors":"M. Saad, I. Hajj, E. Saikaly","doi":"10.21037/gist-20-3","DOIUrl":"https://doi.org/10.21037/gist-20-3","url":null,"abstract":"Small bowel gastrointestinal stromal tumor (GIST) is an uncommon tumor, with an estimated frequency of 10–20/L million population, occurring usually in the 6 decade of life. GISTs, mainly ones larger than 4 cm have a wide range of presentations from abdominal discomfort and bloating to abdominal emergencies due to massive gastrointestinal (GI) hemorrhage, with pressure necrosis and ulceration of the overlying mucosa is the main mechanism leading to GI hemorrhage. Life-threatening hemorrhage is a rare initial presentation. Among the wide differential diagnosis for GI bleeding, jejunal GIST is one of the rarest etiologies. Due to its location and hence the inability to identify by endoscopy it is difficult to diagnose. From here, computed tomography (CT) angiography is considered essential for identification of the site of GI bleed, which aids in diagnosis of GIST. The mainstay treatment for this emergent presentation is resection, which if done in a timely manner results in a good clinical outcome. Herein, we report a case of a 46-yearold male patient presenting with massive GI bleed from jejunal GIST, leading to hemodynamic instability, requiring massive transfusion protocol managed by small bowel resection, after failure of radiologic embolization. In rare instances GISTs present as massive GI bleeding necessitating admission to the hospital and urgent interference. In our case the early multidisciplinary approach manifested by involvement of interventional radiology with the surgical team was the cornerstone in the successful management of our patient and should be considered in all cases of massive upper GI bleeding.","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43400259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the CARE guideline as reporting standard in the Gastrointestinal Stromal Tumor","authors":"","doi":"10.21037/gist.2019.10.02","DOIUrl":"https://doi.org/10.21037/gist.2019.10.02","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47422586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avapritinib: preclinical studies of a promising novel therapeutic option for gastrointestinal stromal tumors","authors":"M. Urbini","doi":"10.21037/GIST.2019.01.03","DOIUrl":"https://doi.org/10.21037/GIST.2019.01.03","url":null,"abstract":"Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal tumor of the gastrointestinal tract (80%), with an annual incidence of 10–15 cases per million people (1). GISTs have become a paradigm for the use of molecular diagnostics and targeted therapy, since its molecular classification is able to predict treatment response. Most GISTs are driven by activating mutations in KIT (70–80% of cases) or PDGFRA (10%) receptor tyrosine kinases. This discovery represents the rationale of the efficacy of target therapies efficacy using small molecule tyrosine kinase inhibitors (TKIs) for this malignancy (1,2).","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/GIST.2019.01.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44573759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Imaging of Gastrointestinal Stromal Tumor","authors":"Tomohiro Yoneyama, Bae Hyeyeol, Yoshio Kitazume, M. Kishino, U. Tateishi","doi":"10.1007/978-981-13-3206-7_4","DOIUrl":"https://doi.org/10.1007/978-981-13-3206-7_4","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-981-13-3206-7_4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51078412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of advanced gastrointestinal adenocarcinoma complicated with high-risk gastrointestinal stromal tumors (GISTs) in an elderly male patient: a case report and literature review","authors":"L. Chen, Tao Chen","doi":"10.21037/gist.2019.01.02","DOIUrl":"https://doi.org/10.21037/gist.2019.01.02","url":null,"abstract":"Currently, coexistence of gastrointestinal adenocarcinoma and gastrointestinal stromal tumors (GISTs) is still infrequent. What’s more, there are few guidelines for the drug therapy of both types of synchronous tumors. Here, we report such a dangerous case and review the related literature for a better treatment. A 79-year-old male patient was admitted to our hospital for abdominal pain and diarrhea more than a month and stopped relieve nature nine days. He was preliminarily diagnosed as sigmoid colon adenocarcinoma and GISTs after having a Computed Tomography scan at another hospital. After gastroscopy, colonoscopy and pathological examination, we further diagnosed synchronous advanced colorectal cancer (CRC) and high-risk GISTs. Through literature review and medical records, we carefully developed the treatment protocol for this case, which is the chemotherapy plan for gastrointestinal adenocarcinoma plus imatinib. There is still insufficient evidence on the safety and efficacy of the regimen and more research and trials are needed to evaluate it.","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/gist.2019.01.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49369926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Classification","authors":"H. Kikuchi, Hiroyuki Konno, Hiroya Takeuchi","doi":"10.1007/978-981-13-3206-7_5","DOIUrl":"https://doi.org/10.1007/978-981-13-3206-7_5","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-981-13-3206-7_5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51078205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Guidelines","authors":"Muranaka Tetsuhito, Y. Komatsu","doi":"10.1007/978-981-13-3206-7_6","DOIUrl":"https://doi.org/10.1007/978-981-13-3206-7_6","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-981-13-3206-7_6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51078371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Agents for Gastrointestinal Stromal Tumors","authors":"Y. Naito, T. Doi","doi":"10.1007/978-981-13-3206-7_11","DOIUrl":"https://doi.org/10.1007/978-981-13-3206-7_11","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/978-981-13-3206-7_11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51077964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-Line Treatment","authors":"Y. Onozawa","doi":"10.1007/978-981-13-3206-7_8","DOIUrl":"https://doi.org/10.1007/978-981-13-3206-7_8","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51078104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}