Digestive Endoscopy 2015; 27 (Suppl. 1): 23
doi: 10.1111/den.12429
Letters, Techniques and Images Future potential of EUS in the upper gastrointestinal tract Diagnostic potential of endoscopic ultrasonography-elastography for gastric submucosal tumors Elastography is a type of virtual biopsy that attempts to assess differences in elasticity between normal and tumor tissue. On elastographic images, soft tissues are shown in red and hard tissues in blue. Giovannini et al. first proposed a qualitative scoring system based on the lesion color pattern, where hard blue lesions were classified as malignant.1 In patients with gastric submucosal tumors (SMT), endoscopic ultrasonography (EUS)-elastography can add valuable information and enhance diagnostic accuracy.2 Here we show typical cases in Figure 1 and 2. However, a limitation exists because gastrointestinal stromal tumor (GIST) malignancy is assessed on the basis of size and number of mitoses per 50 high-power fields. We can predict the presence of GIST by elastography, but not the malignant potential. GIST 2–5 cm in diameter is needed to evaluate malignant features on computed tomography and EUS or to definitively diagnose GIST on histological examination by EUS-fineneedle aspiration (FNA). Contrast-enhanced harmonic EUS (CEH-EUS) may also be useful for diagnosis.3 CEH-EUS detected irregular vessels in high-grade rather than in lowgrade malignant GIST and may play an important role in predicting the malignancy risk of GIST.4 EUS-elastography imaging offers supplemental information that enhances conventional EUS imaging. It might improve the characterization and differentiation between benign and malignant masses during EUS. The diagnostic flow chart for gastric SMT states that if SMT is
doi: 10.1111/den.12429
Letters, Techniques and Images Future potential of EUS in the upper gastrointestinal tract Diagnostic potential of endoscopic ultrasonography-elastography for gastric submucosal tumors Elastography is a type of virtual biopsy that attempts to assess differences in elasticity between normal and tumor tissue. On elastographic images, soft tissues are shown in red and hard tissues in blue. Giovannini et al. first proposed a qualitative scoring system based on the lesion color pattern, where hard blue lesions were classified as malignant.1 In patients with gastric submucosal tumors (SMT), endoscopic ultrasonography (EUS)-elastography can add valuable information and enhance diagnostic accuracy.2 Here we show typical cases in Figure 1 and 2. However, a limitation exists because gastrointestinal stromal tumor (GIST) malignancy is assessed on the basis of size and number of mitoses per 50 high-power fields. We can predict the presence of GIST by elastography, but not the malignant potential. GIST 2–5 cm in diameter is needed to evaluate malignant features on computed tomography and EUS or to definitively diagnose GIST on histological examination by EUS-fineneedle aspiration (FNA). Contrast-enhanced harmonic EUS (CEH-EUS) may also be useful for diagnosis.3 CEH-EUS detected irregular vessels in high-grade rather than in lowgrade malignant GIST and may play an important role in predicting the malignancy risk of GIST.4 EUS-elastography imaging offers supplemental information that enhances conventional EUS imaging. It might improve the characterization and differentiation between benign and malignant masses during EUS. The diagnostic flow chart for gastric SMT states that if SMT is
