Noninvasive Diagnostic Method for Gastric Subepithelial Tumors Based on Circularity: A Multicenter Prospective Study

Area of Science:

• Gastroenterology
• Medical Imaging
• Oncology

Background:

• Gastric subepithelial tumors (SETs) and gastrointestinal mesenchymal tumors (GIMTs) present as similar hypoechoic lesions on endoscopic ultrasound (EUS).
• Distinguishing between different types of SETs, particularly leiomyomas, is challenging with current EUS techniques.

Purpose of the Study:

• To prospectively validate the utility of circularity as a diagnostic marker for gastric subepithelial tumors.
• To assess the effectiveness of circularity in differentiating leiomyomas from other SETs.

Main Methods:

• 100 patients with potential GIMTs (1-5 cm) were recruited; 62 with pathological diagnosis were analyzed.
• Circularity was measured from EUS images using image analysis software.
• Diagnostic performance of circularity for leiomyoma prediction was evaluated using receiver operating characteristic analysis.

Main Results:

• Circularity was significantly lower in leiomyomas (0.846) compared to other SETs (0.924).
• The area under the ROC curve for circularity predicting leiomyomas was 0.822 at a cutoff of 0.869.
• At this cutoff, accuracy was 82.3%, sensitivity 70%, and specificity 84.6% for diagnosing leiomyomas.

Conclusions:

• Circularity is a useful noninvasive method for excluding leiomyomas in gastric subepithelial tumors (1-5 cm).
• This imaging analysis offers a potential adjunctive tool for differentiating SETs during endoscopic ultrasound examination.