Contrast-enhanced harmonic endoscopic ultrasound can differentiate between gastrointestinal stromal tumors (GISTs) and leiomyomas predict the risk of GISTs, according to a study published in the Scandinavian Journal of Gastroenterology.

Contrast-enhanced harmonic endoscopic ultrasound is already being used in the differential diagnosis of benign tumors and malignant ones. However, its value in the diagnosis of submucosal tumors such as GISTs and leiomyomas is not clear.

Here, a team of researchers from China analyzed the diagnostic efficacy of the technique for submucosal tumors and its possibilities in assessing their malignant potential.

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The team retrospectively analyzed 10 cases of leiomyomas and 38 cases of GISTs. Patients underwent either basic endoscopic ultrasound or contrast-enhanced harmonic endoscopic ultrasound. All patients had tumors smaller than 50 mm in diameter.

Under contrast-enhanced harmonic endoscopic ultrasound, the majority of GISTs showed hyperenhancement (86.9%) or diffuse enhancement (89.5%), while 39.5% showed nonenhancing spots. Almost all GISTs (97.4%) showed noticeable capsule enhancement.

While 50% of leiomyoma cases showed hypoenhancement, and 30% showed nonenhancement. 

The researchers also reported that the differential diagnosis ability of contrast-enhanced harmonic endoscopic ultrasound of benign and malignant tumors was significantly higher than that of basic endoscopic ultrasound.

The appearance time of the signal was significantly faster in the intermediate-high-risk GISTs at 5.1 seconds compared to the very low-low-risk group at 15.5 seconds, the researchers said. Moreover, heterogeneous perfusion and nonenhancing spots were more common in the intermediate-high-risk group.

Finally, using statistical analyses, the authors identified intratumoral irregularity as an independent predictor of moderate to high-risk GIST with 73.3% sensitivity, 91.3% specificity, and 84.2% accuracy.

GISTs are rare soft-tissue tumors that develop from the interstitial cells of Cajal of the wall of the gastrointestinal tract. Leiomyomas, on the other hand, are benign soft-tissue neoplasms arising from smooth muscles. 


Wu J, Zhuang M, Zhou Y, et al. The value of contrast-enhanced harmonic endoscopic ultrasound in differential diagnosis and evaluation of the malignant risk of gastrointestinal stromal tumors (<50mm). Scand J Gastroenterol. Published online November 11, 2022. doi:10.1080/00365521.2022.2144437