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

Yizhen Zhang; Qingwei Jiang; Qiang Wang; Yunlu Feng; Dongsheng Wu; Tao Guo; Shengyu Zhang; Xi Chen; Yingyun Yang; Wen Shi; Xi Wu; Aiming Yang

doi:10.2147/CMAR.S333333

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

Cancer Manag Res. 2021 Oct 11:13:7735-7745. doi: 10.2147/CMAR.S333333. eCollection 2021.

Authors

Yizhen Zhang¹, Qingwei Jiang¹, Qiang Wang¹, Yunlu Feng¹, Dongsheng Wu¹, Tao Guo¹, Shengyu Zhang¹, Xi Chen², Yingyun Yang¹, Wen Shi¹, Xi Wu¹, Aiming Yang¹

Affiliations

¹ Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
² Department of Gastroenterology, Yihe Hospital, Zhengzhou, Henan Province, People's Republic of China.

Abstract

Purpose: 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: CA19-9; bilirubin; endoscopic tissue sampling; malignant biliary stricture; radiology.

Grants and funding

This work was supported by the National Key Research and Development Program of China [grant number 2016YFC1302802] and Beijing Municipal Science and Technology Project [grant number Z181100001618013].