Three-color risk stratification for improving the diagnostic accuracy for biliary atresia

Chen, Yan; Zhao, Deping; Gu, Shengli; Li, Yahui; Pan, Weihua; Zhang, Yongjun

doi:10.1007/s00330-020-06751-7

Cited by 12 publications

(21 citation statements)

References 32 publications

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“…4 There are accumulating reports of the application of quantitative elastography methods in the diagnosis of BA and prediction of post-HPE outcomes. [5][6][7][8][9][10][11][12] However, these studies vary in the diagnostic performance and prognostic value of elastography, and they have small sample sizes. Thus, we will conduct this systematic review and meta-analysis to synthesise the results and obtain comprehensive evidence on the value of elastography in BA.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis

Yan

Zhou

et al. 2021

BMJ Open

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IntroductionBiliary atresia (BA) is a life-threatening disease with persistent neonatal cholestasis and progressive liver fibrosis. Timely non-invasive diagnosis of BA can result in early hepatic portoenterostomy (HPE) and better prognosis. Quantitative elastography enables the non-invasive measurement of liver stiffness. However, the studies on elastography methods in the diagnosis of BA and the prediction of post-HPE outcomes vary in their results and have small sample sizes. Thus, we propose this systematic review and meta-analysis to obtain comprehensive evidence on the value of elastography in BA.Methods and analysisWe will search the PubMed, Embase and the Cochrane Central Register of Controlled Trials databases for studies evaluating the diagnostic performance of elastography in patients with BA and the prognostic value of postoperative elastography, from inception to 31 December 2020. We plan to use the Quality Assessment of Diagnostic Accuracy Studies-2 list and the Quality In Prognosis Studies tool to assess the risk of bias in the included studies and the study quality. We will evaluate the diagnostic performance of elastography by synthesising the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic OR and summary receiver operating characteristic curve using Meta-Disc V.1.4. We will evaluate the predictive value of elastography after HPE by synthesising the pooled correlation coefficient and pooled OR of prognostic outcomes using STATA V.14. The funnel plot and Egger’s test will be used to evaluate the potential publication bias. Sensitivity analysis will be conducted by examining the estimated effects of individual studies.Ethics and disseminationAs this study is a meta-analysis based on previously published literature, ethical approval is not necessary according to the ethics committee of West China Hospital, Sichuan University. The results of this study will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020162055.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis

Yan

Zhou

et al. 2021

BMJ Open

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“…Besides, precise early BA screening and diagnosis could avoid unnecessary examinations and adverse procedures, which would prolong patients' recovery time and required intensive post-operation care (6). Even though several diagnostic markers and prediction models have been proposed to facilitate effective BA diagnosis, all of them have displayed either unsatisfactory sensitivity and specificity or limited applicability or accessibility in the hospital setting (16)(17)(18)(19). The novel nomogram established from our study has been demonstrated as more practicable and precise for BA screening compared with previously proposed prediction models and has potential for clinical application in the future.…”

Section: Discussionmentioning

confidence: 99%

Development and Assessment of Screening Nomogram for Biliary Atresia Based on Hepatobiliary Ultrasonographic Features

Yang

Sun

et al. 2021

Front. Pediatr.

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Objectives: Biliary atresia (BA) is a rare neonatal liver disease of which the early diagnosis remains a challenge for clinicians. Our center has established a nomogram diagnostic model based on clinical characteristics and liver function characteristics. We aim to develop and validate a nomogram that includes additional ultrasound and finds hepatobiliary abnormality with better BA early screening performance.Methods: In this single-center, retrospective cohort analysis, 1,001 neonatal obstructive jaundice (NOJ) patients between 2012 and 2015 were enrolled. Multivariable analysis was used to identify clinical characteristics, laboratory liver function characteristics, and ultrasonic features that may early screen BA. A nomogram was developed to predict the probability of BA using multiple logistic regression analysis. This nomogram was subsequently validated using another cohort of 501 NOJ patients between 2015 and 2017. Calibration curve analysis and decision curve analyses were performed to evaluate and interpret the nomogram's clinical benefits.Results: Gender, direct bilirubin (DB), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), fasting gallbladder visibility, fasting gallbladder filling, and common bile duct visibility were found to have profound statistical significance between the BA and non-BA groups (P < 0.05). The significant features were used to build the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) value of the novel nomogram (0.87) was superior to those of the former nomogram (0.83) and GGT alone (0.81) in the prediction of BA. The calibration curve revealed a close resemblance between the predicted and actual BA probabilities. Also, the net benefit from the decision curve analysis (DCA) of the nomogram (0.54) was superior to those of the former nomogram (0.49) and GGT alone (0.45) at 80% of threshold possibility.Conclusions: The nomogram has demonstrated better performance for BA screening by including additional information of the US finding, holding a promising future as a non-invasive method for BA patients.

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“…Recently, a diagnostic nomogram incorporating the SSWE, gallbladder abnormalities and age showed good discrimination in diagnosing BA, with AUC of 0.898 [ 54 ]. Chen et al [ 55 ]. proposed an algorithm with risk stratification to distinguish BA, which was composed of five predictors: shear wave speed, TC sign, GGT, gallbladder abnormalities and clay stool.…”

Section: Elastographymentioning

confidence: 99%

“…This algorithm showed promising results with an AUC of 0.983. These findings indicate that the combination of elastography, US features and clinical data can obtain a better predictive value for the diagnosis of BA than that yielded by using elastography alone [ 54 , 55 ]. At present, the greatest clinical value of elastography is to assess the liver fibrosis stages, so as to predict the prognosis after KPE [ 46 , 56 , 57 ].…”

Section: Elastographymentioning

confidence: 99%

Ultrasound for the Diagnosis of Biliary Atresia: From Conventional Ultrasound to Artificial Intelligence

Zhou

2021

Diagnostics

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Biliary atresia is an aggressive liver disease of infancy and can cause death without timely surgical intervention. Early diagnosis of biliary atresia is critical to the recovery of bile drainage and long-term transplant-free survival. Ultrasound is recommended as the initial imaging strategy for the diagnosis of biliary atresia. Numerous ultrasound features have been proved helpful for the diagnosis of biliary atresia. In recent years, with the help of new technologies such as elastography ultrasound, contrast-enhanced ultrasound and artificial intelligence, the diagnostic performance of ultrasound has been significantly improved. In this review, various ultrasound features in the diagnosis of biliary atresia are summarized. A diagnostic decision flow chart for biliary atresia is proposed on the basis of the hybrid technologies, combining conventional ultrasound, elastography and contrast-enhanced ultrasound. In addition, the application of artificial intelligence in the diagnosis of biliary atresia with ultrasound images is also introduced.

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Three-color risk stratification for improving the diagnostic accuracy for biliary atresia

Cited by 12 publications

References 32 publications

Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis

Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis

Development and Assessment of Screening Nomogram for Biliary Atresia Based on Hepatobiliary Ultrasonographic Features

Ultrasound for the Diagnosis of Biliary Atresia: From Conventional Ultrasound to Artificial Intelligence

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