{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:03:09Z","timestamp":1788354189713,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is a promising tool for differentiating gastric subepithelial tumors (SETs). However, most published studies have mainly included gastrointestinal stromal tumors (GIST) and leiomyomas in the gastrointestinal tract, not limited to gastric SETs. This study evaluated the diagnostic performance of CH-EUS in gastric SETs encountered in clinical practice. Methods: We retrospectively analyzed 68 patients who underwent CH-EUS for gastric SETs between March 2021 and July 2025 at our institution. Gastric SETs were classified into benign (n = 27: ectopic pancreas, leiomyoma, schwannoma, glomus tumor, plexiform fibromyxoma, desmoid tumor, solitary fibrous tumor, and abscess) and GIST groups (n = 41). CH-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement, were assessed. Histopathological confirmation was obtained through EUS-guided fine-needle biopsy or endoscopic\/surgical resection. Results: The GIST group showed significantly higher rates of arterial enhancement (95.1% vs. 74.1%, p = 0.024), irregular vessels (51.2% vs. 22.2%, p = 0.017), and diffuse enhancement (87.8% vs. 66.7%, p = 0.035) than the benign SETs. The diagnostic performance of arterial enhancement showed a sensitivity of 95.1% and specificity of 25.9%, while irregular vessels demonstrated a sensitivity of 51.2% and specificity of 77.8%, and diffuse enhancement showed a sensitivity of 87.8% and specificity of 33.3%. When combining \u22652 CH-EUS features, the sensitivity and specificity were 92.7% and 33.3%, respectively, with an overall accuracy of 69.1%. The presence of all three features yielded a specificity of 81.5% but a lower sensitivity (46.3%). Conclusions: CH-EUS exhibited a high sensitivity but low specificity in differentiating GISTs from various benign gastric SETs when using a combination of at least two CE-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement.<\/jats:p>","DOI":"10.3390\/diagnostics16010165","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:40:53Z","timestamp":1767602453000},"page":"165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Diagnosing Gastric Subepithelial Tumors"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-6398","authenticated-orcid":false,"given":"Moon Won","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea"},{"name":"Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Chan","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea"},{"name":"Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9721-5734","authenticated-orcid":false,"given":"Gwang Ha","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea"},{"name":"Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bong Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea"},{"name":"Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Kyung","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"744","DOI":"10.5946\/ce.2023.005","article-title":"Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: A multicenter study","volume":"56","author":"Choe","year":"2023","journal-title":"Clin. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"495","DOI":"10.5946\/ce.2023.124","article-title":"Prevalence and natural course of incidental gastric subepithelial tumors","volume":"57","author":"Heo","year":"2024","journal-title":"Clin. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jeon, H.K., and Kim, G.H. (2025). Natural History of Gastric Subepithelial Tumors: Long-Term Outcomes and Surveillance Strategies. J. Clin. Med., 14.","DOI":"10.3390\/jcm14186354"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.humpath.2008.06.025","article-title":"Risk stratification of patients diagnosed with gastrointestinal stromal tumor","volume":"39","author":"Joensuu","year":"2008","journal-title":"Hum. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"541","DOI":"10.6004\/jadpro.2023.14.6.7","article-title":"Surgical Management of Gastrointestinal Stromal Tumors","volume":"14","author":"Townsend","year":"2023","journal-title":"J. Adv. Pract. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1136\/gut.46.1.88","article-title":"Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours","volume":"46","author":"Palazzo","year":"2000","journal-title":"Gut"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/S0016-5107(05)01567-1","article-title":"A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses","volume":"62","author":"Hwang","year":"2005","journal-title":"Gastrointest. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.gie.2009.10.019","article-title":"Accuracy of EUS in the evaluation of small gastric subepithelial lesions","volume":"71","author":"Karaca","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3376","DOI":"10.3748\/wjg.15.3376","article-title":"Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?","volume":"15","author":"Kim","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.gie.2019.07.018","article-title":"Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: A meta-analysis","volume":"91","author":"Facciorusso","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1055\/a-1751-5742","article-title":"Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Deprez","year":"2022","journal-title":"Endoscopy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1016\/j.gie.2008.12.004","article-title":"EUS contrast agents: What is available, how do they work, and are they effective?","volume":"69","author":"Sanchez","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"306","DOI":"10.5946\/ce.2019.056","article-title":"Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors","volume":"52","author":"Tamura","year":"2019","journal-title":"Clin. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164","DOI":"10.5946\/ce.2023.074","article-title":"Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions","volume":"57","author":"Yamashita","year":"2024","journal-title":"Clin. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/1751-2980.12710","article-title":"Value of contrast-enhanced harmonic endoscopic ultrasonography in differentiating between gastrointestinal stromal tumors: A meta-analysis","volume":"20","author":"Tang","year":"2019","journal-title":"J. Dig. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3754","DOI":"10.1007\/s00464-020-07585-6","article-title":"Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: A systematic review and meta-analysis","volume":"34","author":"Yang","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.dld.2019.02.017","article-title":"Noninvasive prediction model for diagnosing gastrointestinal stromal tumors using contrast-enhanced harmonic endoscopic ultrasound","volume":"51","author":"Cho","year":"2019","journal-title":"Dig. Liver Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1080\/00365521.2022.2144437","article-title":"The value of contrast-enhanced harmonic endoscopic ultrasound in differential diagnosis and evaluation of malignant risk of gastrointestinal stromal tumors (<50mm)","volume":"58","author":"Wu","year":"2023","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1055\/s-0031-1281676","article-title":"The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications","volume":"33","author":"Piscaglia","year":"2012","journal-title":"Ultraschall. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.3748\/wjg.v23.i14.2493","article-title":"Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review","volume":"23","author":"Lin","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1053\/hupa.2002.123545","article-title":"Diagnosis of gastrointestinal stromal tumors: A consensus approach","volume":"33","author":"Fletcher","year":"2002","journal-title":"Hum. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.3109\/00365521.2012.729082","article-title":"Contrast-enhanced harmonic endoscopic ultrasound is able to discriminate benign submucosal lesions from gastrointestinal stromal tumors","volume":"47","author":"Kannengiesser","year":"2012","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"55","DOI":"10.4103\/2303-9027.200216","article-title":"Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors","volume":"6","author":"Ignee","year":"2017","journal-title":"Endosc. Ultrasound"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1111\/jgh.13766","article-title":"Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract","volume":"32","author":"Kamata","year":"2017","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1002\/jcu.22195","article-title":"Contrast-enhanced endoscopic ultrasonography can predict a higher malignant potential of gastrointestinal stromal tumors by visualizing large newly formed vessels","volume":"43","author":"Yamashita","year":"2015","journal-title":"J. Clin. Ultrasound"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.gie.2010.10.011","article-title":"Estimation of malignant potential of GI stromal tumors by contrast-enhanced harmonic EUS (with videos)","volume":"73","author":"Sakamoto","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"384","DOI":"10.4103\/2303-9027.195871","article-title":"Can contrast-enhanced harmonic endosonography predict malignancy risk in gastrointestinal subepithelial tumors?","volume":"5","author":"Park","year":"2016","journal-title":"Endosc. Ultrasound"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/j.1443-1661.2012.01331.x","article-title":"Gastric glomus tumor: Analysis of endosonographic characteristics and computed tomographic findings","volume":"25","author":"Baek","year":"2013","journal-title":"Dig. Endosc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4103\/2303-9027.180475","article-title":"The diagnostic value of endoscopic ultrasonography and contrast-enhanced harmonic endoscopic ultrasonography in gastrointestinal stromal tumors","volume":"5","author":"Zhao","year":"2016","journal-title":"Endosc. Ultrasound"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/2303-9027.196917","article-title":"Harmonic contrast-enhanced endoscopic ultrasound fine-needle aspiration: Fact or fiction?","volume":"6","author":"Seicean","year":"2017","journal-title":"Endosc. Ultrasound"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1080\/17474124.2021.1880893","article-title":"Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration versus standard fine-needle aspiration in pancreatic masses: A meta-analysis","volume":"15","author":"Facciorusso","year":"2021","journal-title":"Expert. Rev. Gastroenterol. Hepatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/1\/165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:50:45Z","timestamp":1767603045000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/1\/165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16010165"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16010165","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}