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
Findings | Benign | Malignant |
---|---|---|
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 |
Radiating folds | Regular 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 Mass: smooth Junction with wall: obtuse angle | Ulcer location in mass: eccentric Mass: irregular Junction with wall: acute angle |
Surrounding mucosa | Intact | Distorted or obliterated |
Ulcer shape | Round, oval, or linear | Angular |
Other | Hampton line | |
Healing | Complete | Usually incomplete Occasionally complete, but scar Radiating folds with malignant characteristics |