A new classification of gastric submucosal tumors under EUS based on blood flow signals

Once gastrointestinal stromal tumor is suspected to have a malignant possibility, prompt medical intervention should be initiated. Neovascularization plays a significant role in the initiation and progressing of tumors. This study aims to investigate the morphology and distribution of blood vessels in submucosal tumors (SMTs), thereby providing theoretical support for vascular-targeted therapies.

This study enrolled patients who underwent EUS at the First Medical Center of PLA General Hospital and stored images in the medical system, which were considered as SMTs with a definitive pathological diagnosis. The proportion of various blood flow signal under EUS was counted, and the correlation between blood flow signal and tumor pathology, ultrasonic features, location, and other factors was analyzed.

The overall occurrence rate of blood flow signal in SMTs was 69.4%. Appearance of blood flow signal of intratumor was 38.8%. Among them, spot-like, stripe-like, and patches-like were 26.5%, 10.2%, and 2.0%, respectively. As for peritumoral, the occurrence rate was 46.9% and was 36.7%, 6.1%, and 4.1% of the above 3 blood flow signals. The appearance of blood flow signals showed a significant correlation with the long diameter of the tumor (P = 0.042; odds ratio, 1.142; 95% confidence interval, 1.005-1.297), whereas no apparent correlations were observed between tumor types, presence of anechoic area, boundary, origin layer, and growth patterns.

We propose a new EUS classification of gastric SMTs based on blood flow morphology, revealing a significantly high occurrence rate of blood flow signals in these tumors.