Preoperative prediction of gastrointestinal stromal tumors with high Ki-67 proliferation index based on CT features

Cai-Wei Yang; Xi-Jiao Liu; Lian Zhao; Feng Che; Yuan Yin; Hui-Jiao Chen; Bo Zhang; Min Wu; Bin Song

doi:10.21037/atm-21-4669

Preoperative prediction of gastrointestinal stromal tumors with high Ki-67 proliferation index based on CT features

Ann Transl Med. 2021 Oct;9(20):1556. doi: 10.21037/atm-21-4669.

Authors

Cai-Wei Yang^#^{1

2}, Xi-Jiao Liu^#², Lian Zhao², Feng Che¹, Yuan Yin³, Hui-Jiao Chen⁴, Bo Zhang³, Min Wu^{5

6

7}, Bin Song²

Affiliations

¹ West China School of Medicine, Sichuan University, Chengdu, China.
² Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
⁴ Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
⁵ Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
⁶ Department of Clinic Medical Center, Dazhou Central Hospital, Dazhou, China.
⁷ Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, CA, USA.

^# Contributed equally.

Abstract

Background: To determine whether preoperative computed tomography (CT) features can be used for the prediction of gastrointestinal stromal tumors (GISTs) with a high Ki-67 proliferation index (Ki-67 PI).

Methods: A total of 198 patients with surgically and pathologically proven GISTs were retrospectively included. All GISTs were divided into a low Ki-67 PI group (<10%) and a high Ki-67 PI group (≥10%). All imaging features were blindly interpreted by two radiologists. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive performance of the imaging features.

Results: Imaging features were found to be significantly different between the low and the high Ki-67 PI groups (P<0.05). Wall thickness of necrosis showed the highest predictive ability, with an area under the curve (AUC) of 0.838 [95% confidence interval (CI): 0.627-0.957], followed by necrosis, necrosis degree, hyperenhancement of the overlying mucosa (HYOM), and long diameter (LD) (AUC >0.7, P<0.05). HYOM was the strongest predictive feature for the high Ki-67 PI GISTs group, with an odds ratio (OR) value of 30.037 (95% CI: 5.707-158.106).

Conclusions: Imaging features, including the presence of necrosis, high necrosis degree, thick wall of necrosis, and HYOM were significant predictive indicators for the high Ki-67 PI GISTs group.

Keywords: Gastrointestinal stromal tumors (GIST); Ki-67 proliferation index (Ki-67 PI); computed tomography (CT); imaging features.