Researchers from Japan developed a predictive model for the diagnosis of gastrointestinal stromal tumors (GISTs).

“Our predictive model will be a practical guide for the management of gastric subepithelial lesions,” they wrote in an article they published in the journal Medicine.

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In order to develop their model, the team led by Okada Hiroyuki MD, PhD from the Department of Gastroenterology and Hepatology at Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences in Japan reviewed 89 patients with GISTs,  7 patients with schwannomas, and 28 patients with leiomyomas.

The researchers reported that the tumor was more frequently found along the gastric cardia in patients with leiomyomas compared to those with GISTs or schwannomas.

On the other hand, contrast enhancement and intra-tumoral necrosis were more frequent in patients with GIST or schwannoma compared to patients with leiomyomas.

Finally, the majority GISTs and schwannomas (58.3%) showed uneven echogenicity on endoscopic ultrasonography, whereas only 21.4% of leiomyomas showed uneven echogenicity.

The researchers found no difference between the patients in terms of tumor color and bleeding, the presence or absence of ulcer formation, the irregularity of the tumor margin, the cystic spaces, and hyperechoic spots.

“Based on these results, we developed a 2-step diagnostic algorithm for GISTs/schwannomas,” the researchers wrote. 

In the first step, they considered whether or not the tumor was in a cardiac location. If so it was judged as a leiomyoma and if not as a GIST or schwannoma. This allowed for 96.9% sensitivity and 57.1% specificity for the diagnosis of GISTs or schwannomas.

In the second step, tumors were given a point for each of the following features: non-cardiac location, positive contrast enhancement, intra-tumoral necrosis, and uneven echogenicity. Tumors with a score of 2, 3, or 4 were judged as GISTs or schwannomas while those with a score of 1 were judged as leiomyomas. This way the sensitivity and specificity for GIST or schwannoma diagnosis were 81.3%. and 92.9% respectively. 

“(…) we hope that our predictive model will be a practical guide for the management of these lesions in different levels of healthcare delivery systems,” the researchers concluded. 


Okanoue S, Iwamuro M, Tanaka T, et al. Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach. Medicine (Baltimore). 2021;8;100(40):e27520. doi:10.1097/MD.0000000000027520