| Summary: | 碩士 === 國立臺灣大學 === 臨床醫學研究所 === 105 === Gastrointestinal stromal tumors (GISTs) account for the largest proportion of gastric subepithelial tumors (SETs). Endoscopic ultrasound (EUS) is widely used for evaluating gastric SETs, and is sensitive to detect those locate at the fourth layer, name as EUS-suspected gastric GISTs. Since screening endoscopy becomes common, more SETs are discovered and the incidence of EUS-suspected gastric GISTs are increasing. Under current National Comprehensive Cancer Network (NCCN) guidelines, the management of small GISTs with size less than 2 cm remains controversial. There is also no prospective study to assess the interval of EUS surveillance of small GIST.
In a retrospective study, 50 patients with EUS-suspected gastric GISTs of sizes less than 3 cm were followed up by EUS at least twice over a period of more than 24 months, subgroup larger than 1.4cm was associated with significant progression. Other important factors of tumor progression include initial tumor size and irregular tumor border. Due to challenging tissue acquisition and lack of definite pathological diagnosis, current studies about EUS-suspected gastric GISTs have limitations. Concerning possible hyperplasia-neoplasia sequence, whether small GISTs are considered as self-limiting benign lesion or pre-malignant lesion are still under debate. The aims of our study are to (i) validate the endoscopic incisional biopsy as an alternative and safe method for diagnostic yield of small fourth layer subepithelial tumors, particularly GISTs, (ii) study the pathologic and molecular characteristics of small gastric GISTs prospectively.
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