Journal List > J Korean Med Assoc > v.50(9) > 1041948

Kang: Clinical Practice Guideline for Adequate Diagnosis and Effective Treatment of Gastrointestinal Stromal Tumor in Korea


Despite the rarity in incidence and prevalence, gastrointestinal stromal tumor (GIST) has emerged as a distinct pathogenetic entity, and the clinical management of GIST has been evolving very rapidly due to the recent recognition of its oncogenic signal transduction pathway and the introduction of new molecular?targeted therapy. Successful management of GIST in localized and advanced stages requires a multidisciplinary approach firmly based on accurate histopathologic diagnosis. However, standardized guidelines for the management of Korean GIST patients do not exist. This study was performed to provide a guideline for standardized diagnosis and treatment for GIST in Korea. Expert panel members of the Korean GIST Study Group (KGSG) thoroughly reviewed the relevant literature including European Society of Medical Oncology and National Comprehensive Cancer Network guidelines and shared their experience and opinions to make a consensus on twenty?five topics related with pathologic diagnosis, surgical management, and medical treatment of GIST. The consensus described in this article was presented as the basis for a guideline of diagnosis and treatment for patients with GIST that would be used to facilitate the optimal clinical practice in Korea.


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Figure 1.
Photograph of the representative findings of gastrointestinal stromal tumors (GISTs). A) Epithelioid type GIST. B) Spindle cell type GIST. C) Mixed epithelioid and spindle cell type GIST. D) Hyaline changes observed in GIST. E) Myxoid changes observed in GIST. F) Ischemic tumor necrosis observed in GIST.
Figure 2.
Immunohistochemical staining of c?kit in gastrointestinal stromal tumor. c?kit is diffusely positive in the cytoplasm and membranes (A&B). In this picture, internal negative control is vascular endothelial cells. Sometimes, c?kit is more intensely stained along the membrane (C). Less frequently, perinuclear golgi?like staining can be observed (D).
Figure 3.
Algorithm to diagnose gastrointestinal stromal tumors based on immunohistochemistry.
Table 1.
Proposed approach for defining risk of aggressive behavior in GISTs
  Size Mitotic Count
Very low risk < 2 cm ≤ 5 / 50 HPF
Low risk 2~5 cm ≤ 5 / 50 HPF
Intermediate risk < 5 cm 6~10 / 50 HPF
5~10 cm ≤ 5 / 50 HPF
High risk > 5 cm > 5 / 50 HPF
>10 cm Any mitotic rate
Any size >10 /50 HPF

Abbreviation: HPF, high?power field.

Table 2.
Risk stratification of primary GISTs
Tumor features Risk of tumor progression
Mitotic index Size (cm) Stomach Small bowel
≥ 5 / 50 HPF ≤ 2 Very low Very low
> 2 and ≤ 5 Very low Low
> 5 and ≤ 10 Low Moderate
> 10 Moderate High
≥ 5 / 50 HPF ≤ 2 Very low Moderate
> 2 and ≤ 5 Moderate High
>5 and ≤10 High High
>10 High High

GISTs arising at other anatomical sites should probably be stratified in a similar fashion as small bowel tumors

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