Comparison of different noninvasive diagnostic methods for biliary atresia: a meta-analysis

He, Jinpeng; Hao, Yun; Wang, Xiaolin; Yang, Xiao-Jin; Shao, Jingfan; Feng, Jiexiong

doi:10.1007/s12519-015-0071-x

Cited by 21 publications

(18 citation statements)

References 46 publications

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“…Family history is typically noninformative, but in selected circumstances can direct investigations toward specific inherited disorders like Alagille syndrome or familial intrahepatic cholestasis. Additional diagnostic investigations are typically warranted, and noninvasive approaches are often the first to be considered [23]. In the current study, only the presence of gallbladder was considered on ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

Initial assessment of the infant with neonatal cholestasis—Is this biliary atresia?

et al. 2017

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IntroductionOptimizing outcome in biliary atresia (BA) requires timely diagnosis. Cholestasis is a presenting feature of BA, as well as other diagnoses (Non-BA). Identification of clinical features of neonatal cholestasis that would expedite decisions to pursue subsequent invasive testing to correctly diagnose or exclude BA would enhance outcomes. The analytical goal was to develop a predictive model for BA using data available at initial presentation.MethodsInfants at presentation with neonatal cholestasis (direct/conjugated bilirubin >2 mg/dl [34.2 μM]) were enrolled prior to surgical exploration in a prospective observational multi-centered study (PROBE–NCT00061828). Clinical features (physical findings, laboratory results, gallbladder sonography) at enrollment were analyzed. Initially, 19 features were selected as candidate predictors. Two approaches were used to build models for diagnosis prediction: a hierarchical classification and regression decision tree (CART) and a logistic regression model using a stepwise selection strategy.ResultsIn PROBE April 2004-February 2014, 401 infants met criteria for BA and 259 for Non-BA. Univariate analysis identified 13 features that were significantly different between BA and Non-BA. Using a CART predictive model of BA versus Non-BA (significant factors: gamma-glutamyl transpeptidase, acholic stools, weight), the receiver operating characteristic area under the curve (ROC AUC) was 0.83. Twelve percent of BA infants were misclassified as Non-BA; 17% of Non-BA infants were misclassified as BA. Stepwise logistic regression identified seven factors in a predictive model (ROC AUC 0.89). Using this model, a predicted probability of >0.8 (n = 357) yielded an 81% true positive rate for BA; <0.2 (n = 120) yielded an 11% false negative rate.ConclusionDespite the relatively good accuracy of our optimized prediction models, the high precision required for differentiating BA from Non-BA was not achieved. Accurate identification of BA in infants with neonatal cholestasis requires further evaluation, and BA should not be excluded based only on presenting clinical features.

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Section: Discussionmentioning

confidence: 99%

Initial assessment of the infant with neonatal cholestasis—Is this biliary atresia?

et al. 2017

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“…17 Although radiologic investigations (such as ultrasound, MRI, and hepatobiliary scintigraphy) were reported to be helpful in differentiating BA from other obstructive cholestasis, they are time consuming and costly. [18][19][20][21][22][23] Therefore, an effective biomarker would be extremely valuable for the preoperative diagnosis of BA.…”

Section: What This Study Addsmentioning

confidence: 99%

Serum MMP-7 in the Diagnosis of Biliary Atresia

et al. 2019

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BACKGROUND: The overlapping features of biliary atresia (BA) and other neonatal cholestasis with alternative causes (non-BA) have posed challenges for diagnosis. Matrix metalloproteinase-7 (MMP-7) has been reported to be promising in diagnosing BA. We aimed to validate the diagnostic accuracy of MMP-7 for BA in a large population sample. METHODS: We enrolled 288 patients with neonatal obstructive jaundice from March 2017 to October 2018. Serum MMP-7 levels were measured by using an enzyme-linked immunosorbent assay. Receiver operating characteristic curves were constructed, and decision curve analysis was done. A Pearson correlation coefficient test was conducted to assess the correlation between MMP-7 levels and other characteristics. RESULTS: The median serum MMP-7 levels were 38.89 ng/mL (interquartile range: 22.96-56.46) for the BA group and 4.4 ng/mL (interquartile range: 2.73-6.56) for the non-BA group (P , .001). The area under the receiver operating characteristic curve value was 0.9829 for MMP-7, and the sensitivity, specificity, positive predictive value, and negative predictive value were 95.19%, 93.07%, 97.27%, and 91.43%, respectively, at a cutoff value of 10.37 ng/mL. When MMP-7 was combined with g glutamyl transferase, the diagnostic accuracy was slightly improved without significance when compared with MMP-7 alone and had an area under the curve of 0.9880 (P = .08). Decision curve analysis also showed potential for MMP-7 to be used for clinical applications. A significant correlation was found with fibrosis stage from liver biopsy (R = 0.47; P , .001). CONCLUSIONS: MMP-7 demonstrated good accuracy in diagnosing BA and holds promise for future clinical application. Furthermore, its correlation with liver fibrosis indicated its potential use as a therapeutic target or prognostic biomarker.

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“…BA and NH are the two most common causes of neonatal cholestatic jaundice, yet they have similar clinical manifestations. The early correct discrimination of both conditions is mandatory for the outcome of BA and may avoid unnecessary surgery in cases with NH [4]. Hepatobiliary scintigraphy (HBS) using 99m TC-iminodiacetic acid (IDA) derivatives is a widely used functional imaging modality for differentiating BA from NH.…”

Section: Introductionmentioning

confidence: 99%

Role of hepatobiliary scintigraphy with different semi-quantitative parameters along with histopathological scoring in differentiating biliary atresia from neonatal hepatitis

Mohamadien

Makboul

Galal

et al. 2021

Egypt J Radiol Nucl Med

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Background Biliary atresia (BA) and neonatal hepatitis (NH) are the two major causes of neonatal cholestasis (NC). However, both conditions had entirely different therapeutic schedule and prognosis. Considering BA as a surgical emergency, it is pretty important to accurately differentiate the two entities. The aim of the study is to evaluate the diagnostic utility of hepatobiliary scintigraphy (HBS) using a semi-quantitative technique as well as 15-point histopathological scoring system in differentiating BA from NH. Results The sensitivity, specificity, and overall accuracy of HBS in the diagnosis of BA was 90.5%, 80%, and 83.6%, respectively. The median values of kidney-liver ratio (KLR), intestinal-liver ratio (ILR), and background-liver ratio (BLR) were significantly higher in patients with BA, while that of the liver-kidney ratio (LKR) was significantly lower in cases with BA. Moreover, KLR had the largest area under curve (AUC); advocates it to be the best of the semi-quantitative parameters that can predicts BA. Histopathological scoring using a cutoff point ≥ 7 was helpful in discriminating BA from NH with 85.7% sensitivity, 95% specificity and 91.8% accuracy. Conclusions HBS is a non-invasive diagnostic tool frequently used in diagnosis of BA, yet it has a relatively low specificity. To overcome this challenge, we kindly recommend the use of semi-quantitative parameters that could possibly improve the accuracy of HBS for diagnosing BA. Additionally, the use of 15-point scoring for liver biopsy was useful.

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Comparison of different noninvasive diagnostic methods for biliary atresia: a meta-analysis

Abstract: US, HBS and MRCP can be very useful for the diagnostic work-up of neonatal cholestasis. To improve the sensitivity and specificity, several additional measures can be used.

Cited by 21 publications

References 46 publications

Initial assessment of the infant with neonatal cholestasis—Is this biliary atresia?

Initial assessment of the infant with neonatal cholestasis—Is this biliary atresia?

Serum MMP-7 in the Diagnosis of Biliary Atresia

Role of hepatobiliary scintigraphy with different semi-quantitative parameters along with histopathological scoring in differentiating biliary atresia from neonatal hepatitis

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