Development and Validation of a Nomogram for Early Detection of Malignant Gallbladder Lesions

Abstract

OBJECTIVES:Preoperative decision-making for differentiating malignant from benign lesions in the gallbladder remains challenging. We aimed to create a diagnostic nomogram to identify gallbladder cancer (GBC), especially for incidental GBC (IGBC), before surgical resection.METHODS:A total of 587 consecutive patients with pathologically confirmed gallbladder lesions from a hospital were randomly assigned to a training cohort (70%) and an internal validation cohort (30%), with 287 patients from other centers as an external validation cohort. Radiological features were developed by the least absolute shrinkage and selection operator logistic regression model. Significant radiological features and independent clinical factors, identified by multivariate analyses, were used to construct a nomogram.RESULTS:A diagnostic nomogram was established by age, CA19.9, and 6 radiological features. The values of area under the curve in the internal and external validation cohorts were up to 0.91 and 0.89, respectively. The calibration curves for probability of GBC showed optimal agreement between nomogram prediction and actual observation. Compared with previous methods, it demonstrated superior sensitivity (91.5%) and accuracy (85.1%) in the diagnosis of GBC. The accuracy using the nomogram was significantly higher in GBC groups compared with that by radiologists in the training cohort (P < 0.001) and similarly in each cohort. Notably, most of the IGBC, which were misdiagnosed as benign lesions, were successfully identified using this nomogram.DISCUSSION:A novel nomogram provides a powerful tool for detecting the presence of cancer in gallbladder masses, with an increase in accuracy and sensitivity. It demonstrates an unprecedented potential for IGBC identification.

Immunohistochemical analysis of the aggregation of CD1a-positive dendritic cells in resected specimens and its association with surgical outcomes for patients with gallbladder cancer

“…Clinical diagnosis of GBC at an early stage is vitally important because the prognosis after surgery differs markedly according to the T stage [4] . It is often difficult, however, to make a definitive diagnosis based on radiological findings [5] , especially in adenomyomatosis-accompanied cases [6] . Thus, GBC is often detected at an advanced stage, but an effective treatment for unresectable or recurrent GBC has not yet been unequivocally established.…”

Incidental Gallbladder Cancer with the Laparoscopic Treatment in the MRI Era: An Experience at a Single Institution

“…Ultrasonography as a common tool for gallbladder diseases depends largely on the operator's skills 12 , which is characterized with low accuracy. CT and MRI are able to capture more accurate and objective features, which help distinguish the benign from the malignant 13 . MRI shares the same sensitivity and speci city of detection with CT 14 .…”

Development and Validation of a Nomogram for Predicting Survival in Gallbladder Cancer Patients With Recurrence After Surgery

“…Gallbladder cancer (GBC) is a rare tumor with an estimated annual incidence of 3 individuals every 100,000 people, but it remains the most common and aggressive malignancy of the biliary tract associated with poor prognosis ( 1 – 4 ). Surgical resection is regarded as one of the most effective treatments for GBC ( 5 ).…”