Cancer Management and Research (Oct 2021)

Predicting Malignancy of Biliary Stricture with a Nomogram in Patients with a Non-Malignant Endoscopic Tissue Diagnosis: A Retrospective Study

  • Zhang Y,
  • Jiang Q,
  • Wang Q,
  • Feng Y,
  • Wu D,
  • Guo T,
  • Zhang S,
  • Chen X,
  • Yang Y,
  • Shi W,
  • Wu X,
  • Yang A

Journal volume & issue
Vol. Volume 13
pp. 7735 – 7745

Abstract

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Yizhen Zhang,1 Qingwei Jiang,1 Qiang Wang,1 Yunlu Feng,1 Dongsheng Wu,1 Tao Guo,1 Shengyu Zhang,1 Xi Chen,2 Yingyun Yang,1 Wen Shi,1 Xi Wu,1 Aiming Yang1 1Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Gastroenterology, Yihe Hospital, Zhengzhou, Henan Province, People’s Republic of ChinaCorrespondence: Xi Wu; Aiming YangDepartment of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of ChinaEmail [email protected]; [email protected]: The accurate differentiation between benign and malignant biliary stricture is significant but challenging. Tissue diagnosis of biliary stricture by endoscopy sampling can provide excellent specificity but insufficient sensitivity. For patients with suspected malignant biliary stricture (MBS) but non-malignant was reported in endoscopy tissue samples, we constructed a nomogram to predict malignancy and improve the overall diagnostic performance.Patients and Methods: 232 patients with suspected MBS and underwent endoscopy tissue sampling from January 2017 to December 2019 were included, among which 123 patients’ endoscopy tissue samples were classified as non-malignant (including atypical, negative for malignancy, and nondiagnostic). Demographics, serum markers, radiological and sampling results of these 123 patients were collected to construct a nomogram using multivariate analysis.Results: The nomogram was developed based on bilirubin, CA19-9, radiological result, and atypical sampling results and provided an AUC of 0.863 (95% CI 0.795– 0.930) for predicting MBS. The specificity, sensitivity, and accuracy of endoscopy tissue diagnosis were 100.00%, 59.90%, and 68.53%, respectively. With the nomogram added, the overall diagnosis specificity, sensitivity, and accuracy were 95.24%, 89.20%, and 90.23%, respectively.Conclusion: The nomogram can predict malignancy in patients whose endoscopy tissue diagnoses were non-malignant. The overall diagnostic performance was improved with the nomogram added.Keywords: malignant biliary stricture, endoscopic tissue sampling, bilirubin, CA19-9, radiology

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