Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2017; 23(39): 7119-7128
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7119
Laparoscopic finding of a hepatic subcapsular spider-like telangiectasis sign in biliary atresia
Ying Zhou, Meng Jiang, Shao-Tao Tang, Li Yang, Xi Zhang, De-Hua Yang, Meng Xiong, Shuai Li, Guo-Qing Cao, Yong Wang
Ying Zhou, Meng Jiang, Shao-Tao Tang, Li Yang, Xi Zhang, De-Hua Yang, Meng Xiong, Shuai Li, Guo-Qing Cao, Yong Wang, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Zhou Y and Jiang M contributed equally to this work; Tang ST, Zhou Y and Jiang M designed the study; Tang ST supervised the study; Zhou Y collected and analyzed the data; Zhou Y and Jiang M drafted the manuscript; Yang L and Zhang X provided analytical oversight; Yang DH, Xiong M, Li S and Cao GQ revised the manuscript for important intellectual content; Wang Y offered technical or material support; all authors have read and approved the final version to be published.
Supported by the Public Welfare Research Special Fund of the National Health and Family Planning of China, No. 201402007.
Institutional review board statement: All study protocols were approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (Study ID: IORG0003571-1, Feb., 2015).
Informed consent statement: Informed consent was obtained from all the patients.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at tshaotao83@hust.edu.cn. All the participants gave informed consent for data sharing when they enrolled in this study. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shao-Tao Tang, MD, PhD, Professor, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. tshaotao83@hust.edu.cn
Telephone: +86-13720313268 Fax: +86-27-85726402
Received: July 27, 2017
Peer-review started: July 27, 2017
First decision: August 10, 2017
Revised: August 23, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: October 21, 2017
Abstract
AIM

To assess the diagnostic value of a laparoscopic finding of a hepatic subcapsular spider-like telangiectasis (HSST) sign in biliary atresia.

METHODS

A retrospective study was conducted first and then a validation set was used to investigate the value of an HSST sign in predicting biliary atresia (BA). In the retrospective study, laparoscopic images of the liver surface were reviewed in 126 patients with infantile cholestasis (72 BA patients and 54 non-BA cholestasis patients) and a control group of 38 patients with non-hepatic conditions. Analysis was first made by two observers separately and finally, a consensus conclusion was achieved. Then, the diagnostic value of the HSST sign was validated in an independent cohort including 45 BA and 45 non-BA patients.

RESULTS

In the retrospective investigation, an amplified HSST sign was found in all BA patients, while we were unable to detect the HSST sign in 98.1% of the 54 non-BA patients. There was no HSST sign in any of the control subjects. In the first review, the sensitivity and specificity from one reviewer were 100% and 98.1%, respectively, and the results from the other reviewer were both 100%. The consensus sensitivity and specificity were 100% and 98.1%, respectively. The HSST sign was defined as being composed of several enlarged tortuous spider-like vascular plexuses with two to eight branches distributed on all over the liver surface, which presented as either a concentrated type or a dispersed type. In the independent validation group, the sensitivity, specificity, positive predictive value and negative predictive value of the HSST sign were 100%, 97.8%, 97.8% and 100%, respectively.

CONCLUSION

The HSST sign is characteristic in BA, and laparoscopic exploration for the HSST sign is valuable in the diagnosis of BA.

Keywords: Laparoscopic hepatic subcapsular spider-like telangiectasis sign, Infantile cholestasis, Biliary atresia, Infantile hepatitis, Laparoscopy, Diagnosis, Pediatric surgery

Core tip: Color Doppler ultrasound finding of hepatic subcapsular flow has shown much potential for discriminating biliary atresia (BA). While in clinical practice, we have noticed a similar but more intuitive phenomenon - a laparoscopic finding of hepatic subcapsular spider-like telangiectasis (HSST) sign, which may be a specific marker for BA. Based on the current data, we found that the sensitivity and specificity of the HSST sign were each generally close to 100%.