상부 위장관 Stromal Tumor 의 악성 감별진단에 있어서 내시경 초음파 검사의 유용성 = Esophagus, Stomach $ Intestine;The Role of Endoscopic Ultrasonography in Differentiating Benign and Malignant Stromal Tumors of Upper Gastrointestinal Tract

다국어 초록 (Multilingual Abstract)

Background/Aims: Endoscopic ultrasonography (EUS) has been useful in evaluating submucosal lesions of the upper gastrointestinal tract as well as providing guidelines for therapeutic plans. Large proportions of submucosal tumors are diagnosed as stromal tumors. Most are benign, but a significant proportion of them could be malignant. There are a few reports concerning EUS findings as being predictive of malignancy. The aim of this study was to evaluate specific EUS features favoring malignancy in stromal tumors of the UGI tract. Methods: From January, 1992 to June, 1997, thirty-three cases appeared involving stromal tumors (18 benign, 15 malignant (including 8 STUMP)), and were either surgically (27 cases) or endoscopically (6 cases) resected. Videotapes and photographs were reviewed and EUS features that favored the malignancy were analyzed. Results: The mean age was 49 years old and the male to female ratio was 2 : 1. One out of 11 esophageal stromal tumors was malignant, and the figure was significantly lower than the proportions of malignant tumors of the stomach (61.9%). Among EUS features, tumor sizes greater than 4 cm (p$lt;0.05), cystic spaces inside the tumor mass (p$lt;0.05), and inhomogenous echogenicity (p$lt;0.05) were determined to be independent markers associated with malignancy, whereas multiplicity, contour of mass, shape, focal echogenic foci, and shape of the extraluminal border did not show significant association to the malignancy. Most stromal tumors were benign when all of these features suggesting malignancy were absent. Conclusions: Of the various EUS features of UGI tract stromal tumors, tumor size ($gt;4cm), cystic spaces, and inhomogeneous echogenicity were found to be independent features predicting malignancy. Therefore, EUS is a valuable tool for differentiating the malignant nature of stromal tumors of the UGI tract.