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Intraductal Papillary Neoplasm of the Bile Duct: Ultrasound Characteristics and a Novel Biomarker Panel for Invasive
Liya Su1, Qingyu Wu1, Manxia Lin1
1Department of Medical Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Objectives:
To elucidate the clinicopathological characteristics of intraductal papillary neoplasm of the bile duct (IPNB) and evaluate the sensitivity of multi-modality imaging techniques. Specifically, this study aims to: (1) characterize the ultrasound (US) features of intraluminal masses and bile duct dilation patterns; (2) systematically analyze the differential diagnostic criteria between invasive and noninvasive IPNB subtypes.
Methods:
A retrospective cohort study included 48 histopathologically confirmed IPNB patients. Demographic, clinical, and imaging data were retrospectively collected. US features of intraluminal masses and bile duct dilation were systematically described. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal biomarkers for differentiating invasive versus noninvasive IPNB, with sensitivity, specificity, and accuracy calculated.
Results:
The sensitivity rate of IPNB using different imaging methods was as follows: CEUS 39.6%; CECT 32.5%; MRI 29.2%. Arterial enhancement of the intraluminal mass and bile duct dilation was the most important US features, which were detected in 40 (83.3%) and 47 patients (97.9%) respectively. Bile duct dilation can be further classified as cystic dilation/diffuse upstream bile duct dilation/slight peripheral bile duct dilation. Intraluminal mass can be polypoidal-like/plaque-like/invasive pattern. Bilirubin, CEA, and SCC levels differed significantly between invasive/noninvasive groups (all p < 0.05). Notably, when SCC < 0.55 μg/L and total bilirubin (TB) > 29.35 μmol/L were used as diagnostic markers, the diagnostic specificity increased to 100%, with a sensitivity of 54% and an accuracy of 87.5%, showing the best diagnostic performance.
Conclusions:
This study systematically described intraluminal mass morphologies and bile duct dilation patterns in IPNB using CEUS. The combined biomarker criterion (SCC < 0.55 μg/L and TB > 29.35 μmol/L) demonstrated exceptional specificity (100%) and accuracy (87.5%) for differentiating invasive from noninvasive IPNB, providing a potential clinical tool to guide therapeutic strategies.