Can benign and malignant gastric ulcers be distinguished?
Imaging features allow an estimate of the likelihood of malignancy. A malignant or possibly malignant appearance warrants endoscopy and biopsy.
For unequivocally benign radiographic features, radiologic follow-up is a less costly and less invasive alternative. If features equivocal for malignancy develop during follow-up or if healing fails despite adequate medical therapy, endoscopy and biopsy are indicated.
Gastric Ulcers on Upper Gastrointestinal Series: Benign and Malignant Features
|Location in stomach||Other than upstream half of stomach along greater curvature||Upstream half of stomach along greater curvature|
|Profile view: relationship of ulcer to lumen||Beyond expected lumen||Within expected lumen|
To margin of ulcer or to ulcer mound (of edema)
|Nodular, irregular, fused, clubbed, or amputated|
May not reach ulcer margin
|If ulcer is within a mass||Ulcer location in mass: central|
Junction with wall: obtuse angle
|Ulcer location in mass: eccentric|
Junction with wall: acute angle
|Surrounding mucosa||Intact||Distorted or obliterated|
|Ulcer shape||Round, oval, or linear||Angular|
Occasionally complete, but scar
Radiating folds with malignant characteristics