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Yuan K, Zhang X, Yang Q, Deng X, Deng Z, Liao X, Si W. Risk prediction and analysis of gallbladder polyps with deep neural network. Comput Assist Surg (Abingdon) 2024; 29:2331774. [PMID: 38520294 DOI: 10.1080/24699322.2024.2331774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
The aim of this study is to analyze the risk factors associated with the development of adenomatous and malignant polyps in the gallbladder. Adenomatous polyps of the gallbladder are considered precancerous and have a high likelihood of progressing into malignancy. Preoperatively, distinguishing between benign gallbladder polyps, adenomatous polyps, and malignant polyps is challenging. Therefore, the objective is to develop a neural network model that utilizes these risk factors to accurately predict the nature of polyps. This predictive model can be employed to differentiate the nature of polyps before surgery, enhancing diagnostic accuracy. A retrospective study was done on patients who had cholecystectomy surgeries at the Department of Hepatobiliary Surgery of the Second People's Hospital of Shenzhen between January 2017 and December 2022. The patients' clinical characteristics, lab results, and ultrasonographic indices were examined. Using risk variables for the growth of adenomatous and malignant polyps in the gallbladder, a neural network model for predicting the kind of polyps will be created. A normalized confusion matrix, PR, and ROC curve were used to evaluate the performance of the model. In this comprehensive study, we meticulously analyzed a total of 287 cases of benign gallbladder polyps, 15 cases of adenomatous polyps, and 27 cases of malignant polyps. The data analysis revealed several significant findings. Specifically, hepatitis B core antibody (95% CI -0.237 to 0.061, p < 0.001), number of polyps (95% CI -0.214 to -0.052, p = 0.001), polyp size (95% CI 0.038 to 0.051, p < 0.001), wall thickness (95% CI 0.042 to 0.081, p < 0.001), and gallbladder size (95% CI 0.185 to 0.367, p < 0.001) emerged as independent predictors for gallbladder adenomatous polyps and malignant polyps. Based on these significant findings, we developed a predictive classification model for gallbladder polyps, represented as follows, Predictive classification model for GBPs = -0.149 * core antibody - 0.033 * number of polyps + 0.045 * polyp size + 0.061 * wall thickness + 0.276 * gallbladder size - 4.313. To assess the predictive efficiency of the model, we employed precision-recall (PR) and receiver operating characteristic (ROC) curves. The area under the curve (AUC) for the prediction model was 0.945 and 0.930, respectively, indicating excellent predictive capability. We determined that a polyp size of 10 mm served as the optimal cutoff value for diagnosing gallbladder adenoma, with a sensitivity of 81.5% and specificity of 60.0%. For the diagnosis of gallbladder cancer, the sensitivity and specificity were 81.5% and 92.5%, respectively. These findings highlight the potential of our predictive model and provide valuable insights into accurate diagnosis and risk assessment for gallbladder polyps. We identified several risk factors associated with the development of adenomatous and malignant polyps in the gallbladder, including hepatitis B core antibodies, polyp number, polyp size, wall thickness, and gallbladder size. To address the need for accurate prediction, we introduced a novel neural network learning algorithm. This algorithm utilizes the aforementioned risk factors to predict the nature of gallbladder polyps. By accurately identifying the nature of these polyps, our model can assist patients in making informed decisions regarding their treatment and management strategies. This innovative approach aims to improve patient outcomes and enhance the overall effectiveness of care.
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Affiliation(s)
- Kerong Yuan
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, P.R. China
| | - Xiaofeng Zhang
- School of Mechanical Engineering, Nantong University, Nantong, P.R. China
| | - Qian Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P.R. China
| | - Xuesong Deng
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, P.R. China
| | - Zhe Deng
- Department of Emergency Medicine, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, P.R. China
| | - Xiangyun Liao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P.R. China
| | - Weixin Si
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P.R. China
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Wang Y, Peng J, Liu K, Sun P, Ma Y, Zeng J, Jiang Y, Tan B, Cao J, Hu W. Preoperative prediction model for non-neoplastic and benign neoplastic polyps of the gallbladder. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107930. [PMID: 38159390 DOI: 10.1016/j.ejso.2023.107930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians. METHODS We conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors. RESULTS Regression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = -5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872-0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection. CONCLUSION Age, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.
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Affiliation(s)
- Yubing Wang
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiechao Peng
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kui Liu
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peng Sun
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yonghui Ma
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiange Zeng
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yumin Jiang
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bin Tan
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jingyu Cao
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weiyu Hu
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Liu H, Lu Y, Shen K, Zhou M, Mao X, Li R. Advances in the management of gallbladder polyps: establishment of predictive models and the rise of gallbladder-preserving polypectomy procedures. BMC Gastroenterol 2024; 24:7. [PMID: 38166603 PMCID: PMC10759486 DOI: 10.1186/s12876-023-03094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Gallbladder polyps are a common biliary tract disease whose treatment options have yet to be fully established. The indication of "polyps ≥ 10 mm in diameter" for cholecystectomy increases the possibility of gallbladder excision due to benign polyps. Compared to enumeration of risk factors in clinical guidelines, predictive models based on statistical methods and artificial intelligence provide a more intuitive representation of the malignancy degree of gallbladder polyps. Minimally invasive gallbladder-preserving polypectomy procedures, as a combination of checking and therapeutic approaches that allow for eradication of lesions and preservation of a functional gallbladder at the same time, have been shown to maximize the benefits to patients with benign polyps. Despite the reported good outcomes of predictive models and gallbladder-preserving polypectomy procedures, the studies were associated with various limitations, including small sample sizes, insufficient data types, and unknown long-term efficacy, thereby enhancing the need for multicenter and large-scale clinical studies. In conclusion, the emergence of predictive models and minimally invasive gallbladder-preserving polypectomy procedures has signaled an ever increasing attention to the role of the gallbladder and clinical management of gallbladder polyps.
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Affiliation(s)
- Haoran Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Yongda Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Kanger Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Ming Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Xiaozhe Mao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Pinghai Road, Gusu District, Suzhou, 215000, Jiangsu, China.
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Tang C, Geng Z, Wen J, Wang L, You Q, Jin Y, Wang W, Xu H, Yu Q, Yuan H. Risk stratification model for incidentally detected gallbladder polyps: A multicentre study. Eur J Radiol 2024; 170:111244. [PMID: 38043381 DOI: 10.1016/j.ejrad.2023.111244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE We aimed to develop a 4-level risk stratification model using a scoring system based on conventional ultrasound to improve the diagnosis of gallbladder polyp. METHOD Patients with histopathologically confirmed gallbladder polyps were consecutively recruited from three medical centres. Conventional ultrasound findings and clinical characteristics were acquired prior to cholecystectomy. Risk factors for neoplastic and malignant polyps were used to build a risk stratification system via interobserver agreement and multivariate logistic regression analysis. The model was retrospectively trained using 264 pre-surgical samples and prospectively validated using 106 pre-surgical samples. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and malignant polyp rate. RESULTS In total, 370 patients (mean age, 51.68 ± 14.41 years, 156 men) were enrolled in this study. Size (≥12 mm), shape (oblate or round), single, vascularity, gallbladder stone or sludge were considered risk factors for neoplastic polyps. Size (≥14 mm), shape (oblate), single, disrupted gallbladder wall, and gallbladder stone or sludge were risk factors for malignant polyps (all p < 0.05). In the scoring system, the sensitivity, specificity, and AUC of score ≥ 9 in diagnosing neoplastic polyps were 0.766, 0.788, and 0.876 respectively; and the sensitivity, specificity, and AUC of score ≥ 15 in diagnosing malignant polyps were 0.844, 0.926, and 0.949 respectively. In our model, the malignancy rates at the four levels were 0 % (0/24), 1.28 % (2/156), 9.26 % (5/54), and 70.37 % (38/54), respectively. CONCLUSIONS The 4-level risk stratification model based on conventional ultrasound imaging showed excellent performance in classifying gallbladder polyps.
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Affiliation(s)
- Congyu Tang
- Department of Ultrasound, Zhongshan Hospital(Xiamen), Fudan University, China; Department of Ultrasound, Zhongshan Hospital of Fudan University, China
| | - Zhidan Geng
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China
| | - Jiexian Wen
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China
| | - Lifan Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China; Department of Ultrasound, Shanghai Tenth People's Hospital, China
| | - Qiqin You
- Department of Ultrasound, Zhongshan Hospital of Fudan University (Qingpu Branch), China
| | - Yunjie Jin
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China
| | - Huixiong Xu
- Department of Ultrasound, Zhongshan Hospital(Xiamen), Fudan University, China; Department of Ultrasound, Zhongshan Hospital of Fudan University, China; Department of Ultrasound, Zhongshan Hospital(Minhang Meilong), Fudan University (Shanghai Geriatric Medical Center), China
| | - Qing Yu
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China.
| | - Haixia Yuan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, China; Department of Ultrasound, Zhongshan Hospital of Fudan University (Qingpu Branch), China; Department of Ultrasound, Zhongshan Hospital(Minhang Meilong), Fudan University (Shanghai Geriatric Medical Center), China.
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Zhu L, Han P, Jiang B, Zhu Y, Li N, Fei X. Value of Micro Flow Imaging in the Prediction of Adenomatous Polyps. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1586-1594. [PMID: 37012096 DOI: 10.1016/j.ultrasmedbio.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The aim of this study was to assess the value of micro flow imaging (MFI) in distinguishing adenomatous polyps from cholesterol polyps. METHODS A total of 143 patients who underwent cholecystectomy for gallbladder polyps were retrospectively analyzed. B-mode ultrasound (BUS), color Doppler flow imaging (CDFI), MFI and contrast-enhanced ultrasound (CEUS) were performed before cholecystectomy. The weighted kappa consistency test was used to evaluate the agreement of vascular morphology among CDFI, MFI and CEUS. Ultrasound image characteristics, including BUS, CDFI and MFI images, were compared between adenomatous polyps and cholesterol polyps. The independent risk factors for adenomatous polyps were selected. The diagnostic performance of MFI combined with BUS in determining adenomatous polyps was compared with CDFI combined with BUS. RESULTS Of the 143 patients, 113 cases were cholesterol polyps, and 30 cases were adenomatous polyps. The vascular morphology of gallbladder polyps was more clearly depicted by MFI than CDFI, and it had better agreement with CEUS. Differences in maximum size, height/width ratio, hyperechoic spot and vascular intensity on CDFI and MFI images were significant between adenomatous polyps and cholesterol polyps (p < 0.05). The maximum size, height/width ratio, and vascular intensity on MFI images were independent risk factors for adenomatous polyps. For MFI combined with BUS, sensitivity, specificity and accuracy were 90.00%, 94.69% and 93.70%, respectively. Area under the receiver operating characteristic curve (AUC) of MFI combined with BUS was significantly higher than that of CDFI combined with BUS (AUC = 0.923 vs. 0.784). CONCLUSION Compared with CDFI combined with BUS, MFI combined with BUS had higher diagnostic performance in determining adenomatous polyps.
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Affiliation(s)
- Lianhua Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Peng Han
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiang Fei
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
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