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. 2021 Jun 24;13(13):3158. doi: 10.3390/cancers13133158

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© 2021 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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Diagnostic and treatment flow of gastric submucosal tumors and GISTs. Based on the Japanese GIST guidelines, the diagnostic and treatment flow of gastric submucosal tumors, including GISTs, is shown in the upper panel. In the lower panel, the approach to gastric GISTs < 2 cm is indicated according to the NCCN guidelines. $: SMT: submucosal tumor, #: high-risk features: irregular shape, ulcer formation, and/or rapid growth between intervals by endoscopy, and heterogeneous internal echo, irregular shape, and/or regional lymph node swelling by EUS (Ref. [43]), &: “high-risk features” including irregular border, cystic spaces, ulceration, echogenic foci, and heterogeneity (Ref. [2]). The former high-risk features (#) used in the Japanese GIST guidelines are endoscopic and EUS features of submucosal tumors that require treatment, whereas the latter “high-risk features” (&) in the NCCN guidelines include EUS features suggesting small gastric GISTs with potential disease progression.