Integrated Clinical, Radiological, Laboratory, and Pathological Predictors of Malignancy in Pancreaticobiliary Lesions: A Multidisciplinary Retrospective Study.

Abstract

Background: Pancreaticobiliary lesions represent a wide clinical range ranging between harmless inflammatory diseases up to aggressive cancers. Accurate differentiation remains challenging and none of the modalities is predictive enough to predict malignancy. This study compared the combined diagnostic usefulness of the clinical, radiological, laboratory, and histopathological data to predict malignancy. Methods: Group I (n=26) and Group II (n=34) were formed of 60 patients with pancreaticobiliary lesions who were assessed in a tertiary care hospital in this retrospective analytical study. Proper statistical tests were used to compare clinical symptoms, radiological results of transabdominal ultrasonography, contrast-enhanced computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), serum biomarkers and histopathology. Results: Anorexia (88.5% vs 29.4%, p<0.001), weight loss (69.2% vs 26.5%, p=0.002), and jaundice (69.2% vs 38.2%, p=0.034) were significantly more prevalent in malignant cases. EUS demonstrated sensitivity of 96.2% and NPV of 95.2%. CBD diameter on MRCP (14.5±5.9 vs 11.3±2.7 mm, p=0.006), serum bilirubin (median 5.7 vs 1.2 mg/dL, p=0.006), and CA 19-9 (median 236.0 vs 34.0 U/mL, p=0.006) were significantly elevated in the malignant group. Multivariate analysis confirmed anorexia, weight loss, CA 19-9 elevation, jaundice, bilirubin, and CBD diameter as independent predictors of malignancy. Conclusions: Multidisciplinary treatment which combines clinical presentation, EUS, MRCP biliary measurements, serum biomarkers will greatly increase the prediction of malignancy in pancreaticobiliary lesions. These results help to develop a composite predictive scoring model that may be used in clinical practice.