Risk factors to differentiate between benign proximal biliary strictures and perihilar cholangiocarcinoma

Tirotta, Fabio; Giovinazzo, Francesco; Hodson, James; Yates, L.; Tan, Dominic Ti Ming; Salsano, Marco; Baker, Diya; Sundareyan, Ramanivas; Marudanayagam, R.; Dasari, Bobby; Roberts, Keith; Muiesan, Paolo; Isaac, John; Mirza, Darius F.; Mehrzad, Homoyoon; Sutcliffe, Robert P.

doi:10.1016/j.hpb.2020.03.023

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Conversely, the absence of these factors may indicate the presence of a malignant lesion [15]. In cases of patients presenting with indeterminate biliary strictures and atypical biliary cytology ndings, advanced age (≥ 65 years), jaundice, and the identi cation of a mass lesion on imaging may serve as indicators of potential malignancy.…”

Section: Discussionmentioning

confidence: 99%

Development of a Nomogram for Diagnosing Malignant Biliary Strictures: A Retrospective Study

Xia,

Yin,

Han

et al. 2024

Preprint

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Background Diagnosing biliary strictures is a significant clinical challenge. Currently, there is no reliable clinical evaluation system to guide diagnosis and treatment. Aims The aim of this study was to investigate the potential risk factors associated with malignant biliary strictures (MBS) and to develop a nomogram for assessing the malignancy of biliary strictures. Methods Patients with biliary strictures admitted to the First Affiliated Hospital of Nanjing Medical University were included and the medical records of them were analyzed to identify independent risk factors associated with MBS through least absolute shrinkage and selection operator (LASSO) and logistic analysis. Subsequently, a nomogram was established to aid clinical diagnosis. Results The study comprised 602 patients, with 290 patients classified as benign and 312 as malignant. Multivariate analysis demonstrated that symptoms of fever, CA19-9, presence or history of choledocholithiasis, imaging findings of malignancy, and ERCP results indicative of malignancy were identified as independent predictors of MBS, and the AUC value of the nomogram was 0.917 in the training set and 0.897 in the validation set. Conclusions The study identified several independent predictors for determining MBS and constructed a nomogram to assist in the diagnosis of biliary strictures. When the total point of the nomogram was greater than 128.0, the patient was considered to have a high likelihood of MBS.

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Section: Discussionmentioning

confidence: 99%

Development of a Nomogram for Diagnosing Malignant Biliary Strictures: A Retrospective Study

Xia,

Yin,

Han

et al. 2024

Preprint

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“…1 Irregular strictures, a concomitant pancreatic duct stricture ("double duct sign"), a mass lesion with delayed enhancement, secondary signs of malignancy (such as vascular infiltration and evidence of metastases) are signs of MBS. 16,45,46 The presence of a mass and delayed enhancement were reported to differentiate the MBS independently. 45,46 The sensitivity and specificity of cross-sectional radiological imaging for diagnosing MBS were reported to be 67-85% and 63-82%, respectively.…”

Section: Dovepressmentioning

confidence: 99%

“…16,45,46 The presence of a mass and delayed enhancement were reported to differentiate the MBS independently. 45,46 The sensitivity and specificity of cross-sectional radiological imaging for diagnosing MBS were reported to be 67-85% and 63-82%, respectively. 16,17 18F-FDG PET-CT, combining functional and anatomic imaging, plays an important role in malignancy diagnosis.…”

Section: Dovepressmentioning

confidence: 99%

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

Zhang

Jiang

Wang

et al. 2021

CMAR

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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.

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“…Conversely, patients at low risk of pCCA (abdominal pain, low CA19.9, and no mass on CT) will likely have benign disease. Therefore, that subgroup should undergo at least one repeat biopsy in addition to interval imaging and clinical follow-up [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma

et al. 2023

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Cholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered unresectable at the time of diagnosis or exploration. When resective surgery is deemed unfeasible, liver transplantation (LT) could be an effective alternative. The overall survival rates after LT at 1 and 3 years are 91% and 81%, respectively. The overall five-year survival rate after transplantation is 73% (79% for patients with underlying PSC and 63% for de novo pCCA). Multicenter case series reported a 5-year disease-free survival rate of ~65%. However, different protocols, including neoadjuvant therapy, have been proposed. The scarcity of organ availability represents a crucial limiting factor in recommending LT preferentially in treating pCCA. Living donor transplantations and marginal cadaveric allografts have proven to be exciting options to overcome organ shortage. Management of jaundice and cholangitis is still challenging for these patients and could impact LT listing. Whether to adopt surgical resection or LT as standard-of-care in pCCA is still a matter of debate, and more prospective studies are needed.

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Risk factors to differentiate between benign proximal biliary strictures and perihilar cholangiocarcinoma

Cited by 7 publications

References 16 publications

Development of a Nomogram for Diagnosing Malignant Biliary Strictures: A Retrospective Study

Development of a Nomogram for Diagnosing Malignant Biliary Strictures: A Retrospective Study

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

Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma

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