A nationwide German survey on EUS-guided diagnosis and management of suspected Gastrointestinal Stromal Tumors (GIST) – The gap between evidence and “Gut Feeling”

• Published in: Ultraschall in der Medizin - European Journal of Ultrasound
• Main Authors: Eckardt, AJ, Barreiros, AP, Will, U, Burmester, E, Jenssen, C
• Format: Conference Proceeding
• Language: English
• Published: 14.10.2013
• ISSN: 0172-4614; 1438-8782
• DOI: 10.1055/s-0033-1354909

Purpose: To examine practice patterns of EUS-guided diagnosis of suspected GIST in Germany and to assess which criteria are used for making management decisions. Material and methods: An invitation to complete a survey by the German society of Ultrasound Medicine (DEGUM) was sent to all customers of EUS-systems in Germany. In addition, the survey was publicised on the homepage of an EUS special interest group (www.eus-bb.de). To avoid duplicate opinions, participants were asked to only return one survey per institution. Results: 142 centers (17%) of roughly 850 German centers responded. The majority were from regional (74%) or University hospitals (25%). Eighty-five percent perfomed < 5 EUS of subepthelial tumors/month. The majority considered EUS+cytology to be most predictive of a GIST (46%), 27% relied on histologic findings coupled with c-kit -immunohistochemistry and 25% only used EUS criteria. The main criteria to diagnose GIST were the layer of origin (85%) and hypoechoic appearance (80%). C- kit was considered most suggestive for GIST by 98%, but 42% were willing to diagnose GIST with negative cytology and 55% found FNA to be helpful in < 50% of cases. For tissue acquisition 39% used 22G-or 25G-FNA, 33% used 19G-needles and 23% used deep biopsies. Size (79%), extraluminal growth (71%), lymph nodes (64%) and inhomogeneous texture (58%) were considered most important to distinguish malignant from benign lesions. Twenty-one percent of respondents referred all patients with suspected GIST to the surgeon. Criteria prompting referral were symptoms (78%), extraluminal growth (70%), lymph nodes (61%) and size > 5 cm (57%) and less often c-kit (44%). Conclusion: EUS guided-FNA with c-kit immunohistochemistry is considered the standard for the diagnosis of incidental GIST by experts. However, practicing clinicians do not solely rely on FNA, because of a limited yield. Instead, EUS-criteria are frequently used to estimate malignant risk and prompt surgical referral.