title: Estimation of malignant potential of GI stromal tumors by contrast-enhanced harmonic EUS (with videos).
abstract: BACKGROUND
  Contrast-enhanced harmonic EUS (CEH-EUS) is a new sonographic technique that uses US contrast agents and depicts intratumoral vessels in real time.
  
  
  OBJECTIVE
  To evaluate whether assessment of tumor vascularity by CEH-EUS can predict the preoperative malignancy risk of GI stromal tumors (GISTs).
  
  
  METHODS
  Prospective study to observe GIST vascularity.
  
  
  METHODS
  Kinki University School of Medicine.
  
  
  METHODS
  Between June 2007 and September 2009, 76 consecutive patients suspected of having subepithelial lesions underwent CEH-EUS.
  
  
  METHODS
  CEH-EUS was performed by using a prototype echoendoscope in an extended pure harmonic detection mode.
  
  
  METHODS
  Resected GIST specimens in 29 patients who underwent surgical resection were divided into high-grade (n=16) and low-grade (n=13) malignancy groups based on mitotic activity. The abilities of EUS-guided FNA and CEH-EUS to diagnose the malignant potential were compared. The sensitivities with which contrast-enhanced multidetector CT, power-Doppler EUS, and CEH-EUS detected intratumoral vessels in high-grade malignancy GISTs also were compared.
  
  
  RESULTS
  CEH-EUS identified irregular vessels and thereby predicted GIST malignancies with a sensitivity, specificity, and accuracy of 100%, 63%, and 83%, respectively. Diagnosis of high-grade malignancy GISTs by EUS-guided FNA had a sensitivity, specificity, and accuracy of 63%, 92%, and 81%, respectively. Contrast-enhanced multidetector CT, power-Doppler EUS, and CEH-EUS detected intratumoral vessels in high-grade malignancy GISTs with sensitivities of 31%, 63%, and 100%, respectively (P<.05).
  
  
  CONCLUSIONS
  A single center was involved in this study.
  
  
  CONCLUSIONS
  CEH-EUS successfully visualized intratumoral vessels and may play an important role in predicting the malignancy risk of GISTs.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.forename: Shigenaga
authors.initials: S
authors.lastname: Matsui
authors.forename: Ken
authors.initials: K
authors.lastname: Kamata
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Komaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Imai
authors.forename: Kensaku
authors.initials: K
authors.lastname: Dote
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage; D019160:Endosonography / Q000379:methods*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010087:Oxides / Q000008:administration & dosage; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron