{"entity":{"id":"gist-risk-stratification","kind":"term","name":"GIST risk stratification (mitotic count, size, site; Miettinen and modified NIH criteria)","aka":["Miettinen criteria","Miettinen risk","AFIP criteria","modified NIH criteria","Fletcher criteria","Joensuu criteria","GIST risk","GIST risk classification","mitotic count per 5 mm²","mitotic index in GIST","high-risk GIST","intermediate-risk GIST","low-risk GIST","very low risk GIST","tumour rupture in GIST"],"tldr":"Whether a gastrointestinal stromal tumour will come back after surgery is read from three things on the pathology report, its size, how many cells are dividing in a 5 square millimetre field, and where it started (stomach is safer than small bowel or rectum), plus whether it ruptured; high-risk patients get three years of imatinib and the others get none.","summary":"What is measured: the probability that a resected GIST will recur. How: tumour size in centimetres, mitotic count per 5 mm² (about 50 high-power fields; 5 or fewer against more than 5), the site of origin and rupture before or during surgery, read against the Miettinen and Lasota (AFIP, 2006) tables (a gastric tumour of 5 cm or less with 5 or fewer mitoses has a 0 to 2 percent risk; a small-bowel tumour over 10 cm or with more than 5 mitoses a 50 to 90 percent risk), the modified NIH criteria (Joensuu 2008) that add rupture as high risk, and nomograms and contour maps. The genotype is read alongside: KIT exon 11 deletions involving codons 557 and 558 are worse, PDGFRA D842V tumours are indolent and imatinib-insensitive, SDH-deficient tumours follow their own course; KIT (CD117) and DOG1 immunohistochemistry make the diagnosis. What a result changes: high risk or rupture means three years of adjuvant imatinib (SSG XVIII: five-year survival 92 against 82 percent with one year; five years against three is being tested), with the dose and the decision informed by genotype (no adjuvant imatinib for D842V); intermediate risk is discussed case by case; low and very low risk get follow-up only, with imaging intensity set by risk. Where it matters: GIST and its KIT exon 11, PDGFRA D842V and imatinib-resistant pages.","asOf":"2026-09-17","links":[],"tags":[],"related":["kit","pdgfra","imatinib","avapritinib","sdh-deficiency","ihc","tumour-grade","resection-margins"],"cancers":["gist","gist-kit-exon-11","gist-pdgfra-d842v","gist-imatinib-resistant"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Biomarkers"},"route":"/terms/gist-risk-stratification/","neighbours":{"target":[{"id":"kit","kind":"target","name":"KIT","route":"/targets/kit/"},{"id":"pdgfra","kind":"target","name":"PDGFRA","route":"/targets/pdgfra/"}],"drug":[{"id":"avapritinib","kind":"drug","name":"Avapritinib","route":"/drugs/avapritinib/"},{"id":"imatinib","kind":"drug","name":"Imatinib","route":"/drugs/imatinib/"}],"term":[{"id":"tumour-grade","kind":"term","name":"Grade","route":"/terms/tumour-grade/"},{"id":"ihc","kind":"term","name":"Immunohistochemistry (IHC)","route":"/terms/ihc/"},{"id":"resection-margins","kind":"term","name":"Resection margins (R0 / R1 / R2)","route":"/terms/resection-margins/"},{"id":"sdh-deficiency","kind":"term","name":"SDH deficiency (SDHB immunohistochemistry loss)","route":"/terms/sdh-deficiency/"}],"cancer":[{"id":"gist","kind":"cancer","name":"Gastrointestinal stromal tumour (GIST)","route":"/cancers/gist/"},{"id":"gist-imatinib-resistant","kind":"cancer","name":"Imatinib-resistant GIST","route":"/cancers/gist-imatinib-resistant/"},{"id":"gist-kit-exon-11","kind":"cancer","name":"KIT exon 11-mutant GIST","route":"/cancers/gist-kit-exon-11/"},{"id":"gist-pdgfra-d842v","kind":"cancer","name":"PDGFRA D842V-mutant GIST","route":"/cancers/gist-pdgfra-d842v/"}]}}