非恶性内镜组织诊断患者中使用列线图预测胆管狭窄恶性肿瘤：一项回顾性研究

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

作者信息

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

机构信息

Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

Department of Gastroenterology, Yihe Hospital, Zhengzhou, Henan Province, People's Republic of China.

出版信息

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

DOI:10.2147/CMAR.S333333

PMID:34675669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8523316/

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.

摘要

目的

准确鉴别良性和恶性胆管狭窄意义重大但具有挑战性。通过内镜取样进行胆管狭窄的组织诊断可提供出色的特异性，但敏感性不足。对于内镜组织样本报告为非恶性但疑似恶性胆管狭窄（MBS）的患者，我们构建了一个列线图来预测恶性肿瘤并提高整体诊断性能。

患者与方法

纳入2017年1月至2019年12月期间232例疑似MBS并接受内镜组织取样的患者，其中123例患者的内镜组织样本被分类为非恶性（包括非典型、恶性阴性和未诊断）。收集这123例患者的人口统计学资料、血清标志物、影像学和取样结果，采用多因素分析构建列线图。

结果

该列线图基于胆红素、CA19-9、影像学结果和非典型取样结果构建，预测MBS的AUC为0.863（95%CI 0.795-0.930）。内镜组织诊断的特异性、敏感性和准确性分别为100.00%、59.90%和68.53%。加入列线图后，整体诊断特异性、敏感性和准确性分别为95.24%、89.20%和90.23%。