Radiomics in the differential diagnosis of gastrointestinal stromal tumors and leiomyomas. A literature review

.

BACKGROUND: A limited number of studies have been conducted in Russian and world literature on the differential diagnosis of gastrointestinal stromal tumors with other intra-abdominal tumors. The treatment of gastric non-epithelial tumors is dependent on the histologic type. The standard treatment for localized forms of gastrointestinal stromal tumors is surgery. For subepithelial masses up to 2 cm in size, in the absence of endoscopic signs of high risk, a strategy of active surveillance with mandatory endoscopic ultrasound examination and compliance with short-term intervals may be considered. Leiomyomas, benign masses, do not typically necessitate surgical intervention in the absence of clinical symptoms. Therefore, preoperative determination of the tumor type may help to avoid unwarranted surgical intervention. However, the ability of computed tomography to differentiate these tumor types is limited due to the similar radiological picture. Therefore, new scientific and clinical methods are needed. One of the possible techniques is texture analysis (radiomics).

AIM: The study aims to investigate the potential of texture analysis (radiomics) in the diagnosis and differential diagnosis of gastrointestinal stromal tumors and gastric leiomyomas by analyzing the available world scientific literature.

MATERIALS AND METHODS: A search was conducted in PubMed, Scopus, and Web of Science databases for published articles using the following keywords gastrointestinal stromal tumors, leiomyomas, and radiomics. The review included 4 meta-analyses and 16 original articles.

RESULTS: Texture analysis represents a promising tool for quantifying the heterogeneity of masses on radiologic images, thereby enabling the extraction of additional data that cannot be assessed by imaging analysis. The potential applications of texture analysis for differential diagnosis of gastrointestinal stromal tumors with other gastrointestinal neoplasms, risk stratification, and prediction of outcome after surgical treatment, as well as assessment of the mutational status of tumors, were explored. A differential diagnosis of gastrointestinal stromal tumors should be made with other mesenchymal tumors of the stomach (schwannoma, leiomyoma), as well as with malignant tumors (adenocarcinoma, lymphoma), although the number of such publications is limited. Some published studies on texture analysis of gastrointestinal stromal tumors have demonstrated excellent reproducibility of the obtained models.

CONCLUSIONS: The lack of standardization and differences in study methodology present significant challenges to the clinical application of radiomics. Texture analysis may offer a valuable tool for the initial evaluation of gastric tumors, reducing the time required for diagnosis and determining patient management before biopsy. This approach could help to prevent inappropriate treatment.