Differential diagnostic value of periampullary mass: A nomogram established by random forest based on clinical characteristics and contrast‐enhanced ultrasound

Abstract

Purposes: To develop a nomogram model for distinguishing benign from malignant ampullary lesions more intuitive and accurate. Materials and Methods: A total of 124 patients with periampullary lesions from January 2016 to June 2020 were enrolled in this retrospective study. Their clinical information, ultrasound (US), dual contrast-enhanced ultrasound (DCEUS) and MRI image features were used for research. Twenty features were collected in our study. Random forest was used to select the first five most important indicators to construct the prediction model. Results: Patients' age, common bile duct (CBD) diameter, the shape, vascularity, and boundary of lesion, lesion size with or without enlarged after CEUS, the enhancement patterns of arterial phase, the washout patterns of venous phase, CEUS diagnosis, and MRI diagnosis were statistically significant (p < 0.05). After screening for statistically significant indicators by random forest, the first five most important indicators were age,CBD diameter, the enhancement patterns of arterial phase, the washout patterns of venous phase, lesion size with or without enlarged after CEUS, which were used to construct nomogram. The area under curves (AUC) and 95% confidence intervals (CI) for nomogram, MRI + MRCP + DCEUS, DCEUS, MRI + MRCP were 0.98(0.94-1.00), 0.91 (0.84-0.97), 0.89(0.80-0.98), 0.68(0.60-0.77), respectively. The sensitivity and specificity were 100.00% and 84.62% for nomogram, 88.29% and 92.31% for MRI + MRCP+-DCEUS, 86.49% and 92.31% for DCEUS, 51.35%, and 100.00% for MRI + MRCP. Conclusions:We combined clinical indicators, gray-scale ultrasound characteristics, and CEUS characteristics to build the nomogram, which can be intuitively and accurately used for preoperative malignant prediction of ampullary lesion patients, worthy of clinical generalizability and application.

New horizon of contrast‐enhanced sonography in the differential diagnosis of periampullary mass: A random forest nomogram

“…3 This is the first article creating a new contrast-enhanced sonography (CEUS)-related nomogram for differentiating benign from malignant lesions in the periampullary area. 3 The periampullary region is a complex area composed of three histologically and physiologically different anatomical structures, namely, ampulla of Vater, pancreatic duct, and common bile duct. 4 Theoretically, clinical and biological behaviors of the diseases depend on their primary pathological structure.…”

“…In this study, the authors retrospectively analyzed the data of 124 patients with periampullary disease who underwent histological examination and they identified that patient's age, CBD diameter, enhancement pattern of arterial phase, wash-out pattern of venous phase, lesion size after CEUS as five most important indicator of disease characteristics, and, based on this, created a nomogram that predict the disease differentiation between benignity and malignancy. 3 The authors should be praised for suggesting a new nomogram that showed nomogram to be highly diagnostic of periampullary diseases: the area under curves (AUC) and 95% confidence intervals (CI) for nomogram, magnetic resonance imaging (MRI) + MRCP+CEUS (combination of subjective diagnosis by the sonographer and radiologist), CEUS (subjective diagnosis by sonographer), MRI + MRCP (subjective diagnosis by radiologist) were 0.98, 0.91, 0.89, and 0.68 respectively. 3 However, there are some points to consider about this study.…”

“…3 The authors should be praised for suggesting a new nomogram that showed nomogram to be highly diagnostic of periampullary diseases: the area under curves (AUC) and 95% confidence intervals (CI) for nomogram, magnetic resonance imaging (MRI) + MRCP+CEUS (combination of subjective diagnosis by the sonographer and radiologist), CEUS (subjective diagnosis by sonographer), MRI + MRCP (subjective diagnosis by radiologist) were 0.98, 0.91, 0.89, and 0.68 respectively. 3 However, there are some points to consider about this study. First, the study subjects need to be reviewed.…”