Prediction of Pathological Risk Stratification using Computed Tomography Features in Gastrointestinal Stromal Tumours: A Retrospective observational Study

Abstract

Introduction: Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours of gastrointestinal tract. A high postsurgical recurrence and metastatic rate have created a need for a presurgical risk profile identification system. Aim: To assess the association between morphological Computed Tomography (CT) parameters with the pathological risk profile and analyse which CT features can predict the risk grading of GISTs. Materials and Methods: This was a retrospective cohort study based on imaging and histopathological data of 26 patients with pathologically proven GISTs presenting to the Department of Radiodiagnosis of a tertiary hospital in the northern Indian Himalayan foothills over a period of five years from July 2018 to June 2023. CT imaging features including size, growth pattern, margins, enhancement, calcifications, necrosis, intralesional haemorrhage, enlarged feeding vessels, direct organ invasion, and associations such as ascites and lymphadenopathy were studied. All lesions were classified as per Miettinen risk classification into no risk, very low-risk, low, moderate, and high-risk lesions. Analysis was done by the Chi-square test. Predictive analysis was carried out by computing the odds ratio and performing regression analysis on significantly associated imaging features. Results: Out of 26 patients, the study group comprised 16 males (61.54%) and 10 females (38.46%). The most common decade of presentation was the 6th decade with the mean age of presentation being 55.81±4.23 years. Twelve patients were grouped under intermediate to high-risk grading. Lesion size >5 cm (p-value=0.0171, OR=19.12), ill-defined margins (p-value=0.0048, OR=18.33), intralesional necrosis (p-value=0.0053, OR=19.8), and enlarged feeding vessels (p-value=0.012, OR=21.27) were identified as imaging features with significant association and predictive ability for high-risk lesions. The strongest predictive ability for a high-risk profile was shown by ill-defined margins (R2=0.381) and intralesional necrosis (R2=0.3287). Conclusion: A preoperative Contrast Enhanced Computed Tomography (CECT) assessment provides a comprehensive imaging profile for GISTs as well as a fair accuracy of risk profile prediction via various singular and clustered morphological parameters.

Keywords

• calcifications
• enhancement
• miettinen risk classification
• necrosis