Table 2.
Studies on the ability of Contrast-Enhanced Harmonic Endoscopic Ultrasound (CEUS-E) to detect Gastrointestinal Stromal Tumors (GISTs).
| Author | Study | N. GISTs | Lesion Size mm | Echo Pattern | Sensitivity | Specificity | PPV | NPV | AUROC | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|
| Sakamoto et al., 2011 [49] | Prospective | 29 (n = 29 pts) | >30 mm (18/29, 62%) | Type I (regular vessels, homogeneous enhancement): Low-grade malignancy (n = 8); Type II (irregular vessels, heterogeneous enhancement): High-grade malignancy (n = 16), low-grade malignancy (n = 5) |
100% (malignancy prediction based on irregular vessels) | 63% (malignancy prediction based on irregular vessels) | NA | NA | 83% (malignancy prediction based on irregular vessels) | CH-EUS successfully visualized intratumoral vessels and may be useful in predicting GIST malignancy risk |
| Yamashita Y et al., 2015 [52] | Prospective | 13 (n = 13 pts) | 1.9–60 | Hyperenhancement (n = 13/13); vessel positive (n = 6): very low/ low-grade malignancy, 1 (17%); Intermediate/high-grade malignancy, 5 (83%)—vessel negative (n = 7): very low / low-grade malignancy, 7 (100%) | NA | The specificity of rich vascularity determined via CE-EUS for intermediate or high-risk GIST was high | NA | NA | NA | Intratumoral vessels identified using CE-EUS in GISTs are associated with a higher degree of angiogenesis, implying a higher malignant potential |
| Park HY et al., 2016 [55] | Retrospective | 35 | 32.5 ± 12.5 | Irregular vessels: high-grade malignancy (63.6%), low-grade malignancy (46.7%); Heterogeneous perfusion: high-grade malignancy (36.4%), low-grade malignancy (26.7%); Non-enhancing spots: high-grade malignancy (63.6%), low-grade malignancy (46.7%) | 53.8% | 66.7% [N. positive findings > 1 (benign vs. GIST)] | 86.4% [N. positive findings > 1 (benign vs. GIST)] | 46.2% [N. positive findings > 1 (benign vs. GIST)] | 71.4% [N. positive findings > 1 (benign vs. GIST)]; 63.6% (malignancy prediction) | CH-EUS had low sensitivity, specificity, and accuracy in predicting SEL malignancy risk |
| Ignee A et al., 2017 [50] | Prospective | 57 (SELs, n = 62) | 62.6 ± 42.1 (16–200) | Hyperenhancement: 56/57 (98%); avascular areas: 50/57 patients (88%) | 98% | 100% | 100% | 93% | 98% | CH-EUS reveals hyperenhancement and avascular areas in a high percentage of GISTs but not in leiomyoma. GISTs and leiomyoma can thus be distinguished precisely |
| Kannengiesser K et al., 2017 [51] | Prospective | 8 (n = 17 pts) | NA | Hyperenhancement (maximum intensity, 47.3 ± 11.6 db) (n = 8/8) | NA | NA | NA | NA | NA | CH-EUS can accurately distinguish GISTs from benign lesions |
| Kamata K et al., 2017 [54] | Retrospective | 58 (n = 73 pts) | 28 (10–90) | Hyperenhancement: 49/58 (84.5%); inhomogeneous: 21/58 (36.2%) | 84.5% | 73.3% | NA | NA | 82.2% | GISTs were discovered to have hyper-enhancement and inhomogeneous enhancement |
| Pesenti C et al., 2019 [46] | Retrospective | 5 (SELs, n = 14) | 35 | Hyperenhancement: 5/5 (100%) | 100% | NA | NA | NA | NA | CH-EUS could be used in conjunction with EUS to differentiate GISTs from other SELs (early and clear enhancement) |
| Cho IR et al., 2019 [56] | Retrospective | 37 (n = 176 pts) | 2.61 ± 1.71 | Hyperenhancement: 51.4%; positive vascularity: 81.1%; lower LSR: 1.3 | 81.1% (vascularity) | 84.8% (vascularity) | 85.8% (vascularity) | 80% (vascularity) | 82.9% (vascularity) | Upon conducting CH-EUS, the LSR and vascularity of SELs can be used as parameters for a noninvasive GIST prediction model |
| Tang JY et al., 2019 [44] | Meta-analysis | n = 187 pts | 25–63 | Hyperenhancement: 100% | 89% (95%CI 0.82–0.93) | 82% (95%CI 0.66–0.92) | NA | NA | 0.89 | CH-EUS is a noninvasive, safe method for differentiating GIST from benign SELs and, to a lesser extent, predicting their malignant potential |
| Lee HS et al., 2019 [57] | Retrospective | 32 (n = 44 pts) | Low-grade malignancy: 27 (16–50); High-grade malignancy: 34 (15–65) | Low-grade malignancy: irregular vessels 11 (55.0), heterogeneous perfusion 12 (60.0), hyperechoic foci 10 (50.0), non-enhancing spots 11 (55.0); High-grade malignancy: irregular vessels 8 (66.7), heterogeneous perfusion 5 (6.2), hyperechoic foci 8 (66.7), non-enhancing spots 8 (66.7) |
84.4% (perfusion) | 60% (perfusion) | 93.1% (perfusion) | 37.5% (perfusion) | NA | The combination of CH-EUS and perfusion analysis performed with perfusion analysis software may be a quantitative and independent method for predicting malignancy risk in gastrointestinal SELs |
| Lefort C et al., 2021 [58] | Retrospective | 40 (n = 54 pts) | 40 (15–150) | Hyperenhancement (NA) | Diagnostic (GIST): 85%; malignancy GISTs 100% | Diagnostic (GIST): 57.1%; malignancy prediction: 82.1% | NA | NA | Diagnostic (GIST): 77.8%; malignancy prediction: 86.1% | CH-EUS outperformed B-mode EUS with respect to differentiating leiomyomas and risk stratifying GIST. The addition of CH-EUS improved diagnostic accuracy in high-grade GISTs |
Abbreviations: GISTs: Gastrointestinal stromal tumors; SELs: Subepithelial lesions; GI: gastrointestinal; LSR: long-to-short axis ratio.