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Ultraschall Med 2015; 36(05): 494-500
DOI: 10.1055/s-0034-1398970
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

German Survey on EUS-Guided Diagnosis and Management of Gastrointestinal Stromal Tumors (GISTs) – Evidence or “Gut-Feeling”?

Deutsche Fragebogenstudie zur EUS-gesteurten Diagnose und Management Gastrointestinaler Stromatumoren (GIST) – Evidenz oder „Bauchgefühl“
C. Jenssen
1   Department of Internal Medicine/Gastroenterology, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
,
A. P. Barreiros
2   Department of Internal Medicine, Uniklinikum Regensburg, Germany
,
U. Will
3   Department of Internal Medicine/Gastroenterology, SRH Wald-Klinikum, 3. Medizinische Klinik, Gera, Germany
,
E. Burmester
4   Department of Internal Medicine/Gastroenterology, Sana-Kliniken Lübeck, Germany
,
I. Schmidtmann
5   Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg-Universität Mainz, Germany
,
A. J. Eckardt
6   Gastroenterology, DKD Helios Klinik Wiesbaden, Germany
› Author Affiliations
Further Information

Publication History

05 September 2014

27 December 2014

Publication Date:
28 April 2015 (online)

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Abstract

Purpose: To examine practice patterns of endosonographers in diagnosing and managing gastrointestinal stromal tumors (GISTs) in Germany.

Materials and Methods: A modified published survey (Ha et al., Gastrointest Endosc 2009) was sent to endosonographic ultrasound (EUS) customers in Germany. The survey was also publicized on the homepage of an EUS interest group. To avoid duplicate opinions, participants were asked to return one survey per institution.

Results: 142 centers of roughly 850 German EUS centers responded. 25 % were from University hospitals and 74 % from community hospitals. 61 % performed > 2 EUS scans for suspected subepithelial lesions/week. Although 97 % of respondents believed that tissue acquisition with CD117 immunohistochemistry best predicts a GIST, 11 % do not perform EUS-FNA when suspecting a GIST, 68 % perform it occasionally and 18 % perform it regularly. The main EUS criteria used for a suspected GIST are the typical layer (85 %), hypoechoic appearance (80 %) and gastric location (51 %). 69 % would diagnose a GIST with negative CD117 if the EUS criteria and spindle cells are present. FNA was rated helpful in < 50 % by 55 % of participants. Size was the primary criterion for suspecting malignancy. 95 % of respondents would perform surveillance ≥ 1x/year of GISTs that are not resected.

Conclusion: There is significant variability in the diagnosis and management of GISTs in Germany. Diagnostic certainty of EUS-FNA is suboptimal in many centers and EUS is frequently used for guidance. The diagnosis of a GIST is often guided by a “gut feeling” rather than evidence. Efforts should be made to unify existing guidelines.

Zusammenfassung

Ziel: Untersuchung des praktischen Vorgehens endosonographierender Ärzte in Deutschland (GER) bei der Diagnostik und Management von gastrointestinalen Stromatumoren (GIST).

Material und Methode: Ein leicht modifizierter, publizierter Fragebogen (Ha et al, Gastrointest Endosc 2009) wurde an die Kunden von Endosonografie (EUS)-Systemen in GER versandt. Zusätzlich wurde die Umfrage auf der Homepage einer deutschen EUS-Interessensgruppe veröffentlicht. Um Doppelantworten zu vermeiden, baten wir um Rücksendung nur eines Fragebogens pro Institution.

Ergebnisse: 142 von etwa 850 EUS-Kunden antworteten, darunter 25 % aus Universitätsklniken und 74 % aus regionalen Häusern. 61 % führten mehr als 2 EUS/Woche bei Patienten mit subepithelialen Läsionen durch. Wenngleich 97 % der Teilnehmer angaben, dass eine Gewebeentnahme mit CD117-Immunhistochemie einen GIST am besten voraussagt, führen 11 % bei Verdacht auf GIST keine EUS-FNA durch, 68 % tun das gelegentlich und nur 18 % regelmäßig. Die wesentlichen EUS-Kriterien für die Verdachtsdiagnose eines GIST sind die typische Schichtenzuordnung (85 %), Echoarmut (80 %) und Magenlokalisation (51 %). 69 % würden die Diagnose eines GIST auch bei negativer CD117-Immunohistochemie stellen, wenn typische EUS-Kriterien und Spindelzellen nachweisbar wären. 55 % der Teilnehmer gaben an, die EUS-FNA sei in < 50 % der Fälle hilfreich. Tumorgröße war das primäre Kriterium für einen Malignitätsverdacht. 95 % der Umfrageteilnehmer würden GIST, die nicht reseziert werden, mindestens 1 x jährlich überwachen.

Schlussfolgerungen: Kriterien und Methoden zur Diagnose von GIST unterscheiden sich zwischen deutschen Zentren signifikant. Die diagnostische Treffsicherheit der EUS-FNA ist in vielen Zentren suboptimal und das EUS Bild entscheidet häufig über das Vorgehen. Das Management von GIST wird oft eher durch „Bauchgefühl“ als durch Evidenz gesteuert. Anstrengungen zur Vereinheitlichung von Leitlinien sind erforderlich.

Key words

abdomen - stomach - endoscopy - tumor - endoscopic ultrasound - fine-needle aspiration - subepithelial tumors - gastrointestinal stromal tumor - survey
 

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