Proposed modification of the original NIH consensus criteria for risk stratification of GISTs

Risk group	Size (cm)	Mitotic rate* (per 50 HPF)
Original NIH^[1] criteria
Very low risk	<2	<5
Low risk	2 to 5	<5
Intermediate risk	<5	6 to 10
Intermediate risk	5 to 10	<5
High risk	>5	>5
	>10	Any
	Any	>10
Proposed^[2] criteria
Level I	≤5	<5
Level II	<5	6 to 10
Level II	5 to 10	<5
Level III	≤5	>10
	5 to 10	6 to 10
	>10	<5
Level IV	>5	>10

NIH: National Institutes of Health; GIST: gastrointestinal stromal tumor; HPF: high-power fields.
* Mitotic rate is counted in an area of 5 square millimeters (mm²) on the glass slide section. For older microscopes with traditional field size optics, 50 HPF is equivalent to 5 mm². For modern microscopes with wider 40× lenses/fields, 20 HPF is equivalent to 5 mm². If necessary, the field of view should be measured to determine the actual number of HPF required to cover a 5 mm² area.^[3]

References:

Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Path 2002; 10:81.
Huang HY, Li CF, Huang WW, et al. A modification of NIH consensus criteria to better distinguish the highly lethal subset of primary localized gastrointestinal stromal tumors: a subdivision of the original high-risk group on the basis of outcome. Surgery 2007; 141:748.
Rubin BP, Blanke CD, Demetri GD, et al. Protocol for the examination of specimens from patients with gastrointestinal stromal tumor (GIST): Based on AJCC/UICC TNM, 7th edition, College of American Pathologists (CAP), Washington 2013.

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Proposed modification of the original NIH consensus criteria for risk stratification of GISTs