Clinical calculator summary
Original 2006 AFIP/Miettinen GIST Risk Table
Clinical calculator summary
Original 2006 AFIP/Miettinen GIST Risk Table
Looks up historical progressive-disease frequency by supported primary GIST site, raw greatest dimension, and mitoses per calibrated 5 mm².
Evidence-based context for fast calculator use
- Purpose:
- Reproduce all 32 source-table cells without inventing estimates where source data were insufficient.
- Population:
- Adequately resected, untreated primary gastric, duodenal, jejunal/ileal, or rectal GIST without known rupture.
- Factors:
- Primary tumor site, Greatest dimension in cm, Integer mitotic count per calibrated 5 mm², Resection/treatment context, Tumor rupture status
- Reference:
- Miettinen M, Lasota J. Semin Diagn Pathol. 2006;23(2):70-83. DOI 10.1053/j.semdp.2006.09.001.
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AFIP/Miettinen GIST Risk Table (2006)
Clinical Context & Background
This calculator implements the original 2006 Miettinen/Armed Forces Institute of Pathology risk table for primary gastrointestinal stromal tumors. It reports the historical percentage of patients with progressive disease, defined in the source cohorts as metastasis or tumor-related death. The underlying cohorts predated routine imatinib therapy.
The table requires the greatest tumor dimension, an exact supported gastrointestinal site, and a mitotic count normalized to a calibrated 5 mm² tumor area. A generic “50 high-power fields” value must not be used unless the measured microscope field area totals exactly 5 mm². Several duodenal and rectal table cells have insufficient source data; those cells remain unestimated rather than receiving an invented fallback risk.
The table applies to adequately resected, untreated primary GIST without known tumor rupture. Biopsy-only samples can miss a mitotic hotspot. It does not apply automatically after neoadjuvant therapy, to recurrent or metastatic disease, or to unsupported sites. Tumor rupture, molecular subtype, pediatric or syndromic disease, and contemporary management require separate assessment. The result is not AJCC staging, an individualized recurrence model, or a treatment recommendation.
Formula Logic
Original 2006 AFIP/Miettinen lookup table: supported primary GIST site × raw greatest-dimension band (≤2, >2–≤5, >5–≤10, >10 cm) × raw mitotic band (≤5 or >5 mitoses per calibrated 5 mm²).Reference Data
| Mitoses / 5 mm² | Size | Stomach | Duodenum | Jejunum / Ileum | Rectum |
|---|---|---|---|---|---|
| ≤5 | ≤2 cm | None, 0% | None, 0% | None, 0% | None, 0% |
| ≤5 | >2–≤5 cm | Very low, 1.9% | Low, 8.3% | Low, 4.3% | Low, 8.5% |
| ≤5 | >5–≤10 cm | Low, 3.6% | Insufficient data | Moderate, 24% | Insufficient data |
| ≤5 | >10 cm | Moderate, 12% | High, 34% | High, 52% | High, 57% |
| >5 | ≤2 cm | None, 0%* | Insufficient data | High, 50%* | High, 54% |
| >5 | >2–≤5 cm | Moderate, 16% | High, 50% | High, 73% | High, 52% |
| >5 | >5–≤10 cm | High, 55% | Insufficient data | High, 85% | Insufficient data |
| >5 | >10 cm | High, 86% | High, 86% | High, 90% | High, 71% |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use for confirmed, untreated primary GIST after adequate resection and calibrated mitotic assessment.
- Confirm the supported anatomic site, greatest dimension, and absence of known rupture before lookup.
How To Interpret
- The percentage is a historical pre-imatinib cohort frequency of metastasis or tumor-related death.
- Insufficient-data cells remain unestimated; sparse-data cells carry an explicit warning.
- Raw values determine the 2, 5, and 10 cm and 5-mitosis boundaries.
What To Do Next
- Integrate contemporary stage, rupture, genotype, patient factors, and current GIST guidance in specialist multidisciplinary review.
Limitations
- Not applicable to unsupported sites, post-neoadjuvant, recurrent, metastatic, or ruptured tumors.
- Biopsy-only mitotic assessment may miss a hotspot.
- The table does not provide an individualized probability or treatment recommendation.
Validated Population
Original long-term pre-imatinib cohorts of primary gastric, duodenal, jejunal/ileal, and rectal GIST.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed AFIP/Miettinen cases passed through visible production controls at 0%, the source-defined insufficient-data cell, and 71%.
- No unexpected N/A, literal undefined value, stale control, unsupported risk gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/afip-gist-risk-stratification-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/afip-gist-risk-stratification.json.
: Input workflow simplified and revalidated
- Reduced the public form to result-, branch-, unit-, and applicability-changing inputs; removed or consolidated non-scoring, administrative, and duplicate questions.
- Preserved the verified calculation or report-interpretation logic, thresholds, model version, component logic, and supported result pathways behind strict deterministic adapters.
- Passed the calculator-specific regression audit, adapter-parity and malformed-input checks, the 144-calculator input-quality audit, and the 43-calculator entry-burden audit.
: Full validation test
- 512/512 source-table, oracle, raw-boundary, malformed-input, applicability, UI, trace, wording, report, registry, and isolation checks passed.
- No registered master panel calculates AFIP/Miettinen GIST risk; no panel receives inherited verification.
: Calculation and input-contract correction
- Replaced the simplified table with all 32 original AFIP cells, exact percentages, explicit insufficient-data cells, sparse-cohort warnings, and raw 2/5/10 cm and 5-mitosis boundaries; gastric >10 cm with ≤5 mitoses now correctly reports 12%.
- Required six explicit fields, calibrated mitoses per 5 mm², strict missing/extra/type validation, and neutral biopsy, rupture, unsupported-site, post-treatment, recurrent, metastatic, and unconfirmed outcomes; removed invented fallbacks, ranges, and treatment guidance.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
Can I enter mitoses per 50 HPF?
Only if the measured field area of those fields totals exactly 5 mm². Modern microscopes often reach 5 mm² in roughly 20–25 HPFs, so field-area calibration is required.
What does insufficient source data mean?
The selected AFIP table cell did not contain a reliable percentage. The calculator intentionally does not infer or substitute a risk estimate.
Does this result determine adjuvant therapy?
No. The historical table is one part of assessment; rupture, genotype, treatment era, staging, guidelines, and multidisciplinary review remain separate.
Evidence-based oncology decision support. Verify with clinical guidelines.