Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Early postnatal characteristics and differential diagnosis of choledochal cyst and cystic biliary atresia
Yu Tian, Shuai Chen, Can Ji, Xin-Ping Wang, Mao Ye, Xin-Yuan Chen, Jian-Feng Luo, Xu Li, Long Li
Yu Tian, Mao Ye, Xin-Yuan Chen, Jian-Feng Luo, Xu Li, Long Li, Department of Pediatric Surgery, Capital Center for Children’s Health, Capital Medical University, Capital Institute of Pediatrics, Beijing 100020, China
Yu Tian, Can Ji, Xin-Ping Wang, Department of Pediatric Surgery, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing 100020, China
Yu Tian, Precision Regenerative Medicine Research Centre, Medical Science Division, and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau 999078, China
Shuai Chen, Department of Neonatal Surgery, Children’s Hospital Affiliated to Shandong University (Jinan Children’s Hospital), Jinan 250022, Shandong Province, China
Xu Li, Long Li, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences, Beijing 100020, China
Long Li, Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
Co-first authors: Yu Tian and Shuai Chen.
Co-corresponding authors: Xu Li and Long Li.
Author contributions: Tian Y and Chen S contributed equally to this work as co-first authors; Tian Y and Chen S designed the research, collected the data, and wrote the original draft; Ji C and Wang XP performed the data analysis and interpretation; Ye M and Chen XY contributed to methodology and validation; Luo JF conducted statistical analysis; Li X and Li L contributed equally to this work as co-corresponding authors, and were responsible for study conception, supervision, and critical revision of the manuscript; All authors have read and approved the final manuscript to be published and agree to be accountable for all aspects of the work.
Supported by the Beijing Municipal Science and Technology Commission, No. Z191100006619002; Haiyou Health High-Caliber Talent Project, No. 202412; and the Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences, No. 2021RU015.
Institutional review board statement: This study was approved by the Ethics Committee of the Capital Institute of Pediatrics (No. SHERLL2022047).
Informed consent statement: The requirement for patient informed consent was waived due to the retrospective study design.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
lilong23@126.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Long Li, Chief, Chief Physician, Professor, Department of Pediatric Surgery, Capital Center for Children’s Health, Capital Medical University, Capital Institute of Pediatrics, No. 2 Ya Bao Road, Beijing 100020, China.
lilong23@126.com
Received: April 14, 2025
Revised: June 14, 2025
Accepted: August 5, 2025
Published online: September 7, 2025
Processing time: 142 Days and 16.3 Hours
BACKGROUND
Choledochal cysts (CC) and cystic biliary atresia (CBA) present similarly in early infancy but require different treatment approaches. While CC surgery can be delayed until 3-6 months of age in asymptomatic patients, CBA requires intervention within 60 days to prevent cirrhosis.
AIM
To develop a diagnostic model for early differentiation between these conditions.
METHODS
A total of 319 patients with hepatic hilar cysts (< 60 days old at surgery) were retrospectively analyzed; these patients were treated at three hospitals between 2011 and 2022. Clinical features including biochemical markers and ultrasonographic measurements were compared between CC (n = 274) and CBA (n = 45) groups. Least absolute shrinkage and selection operator regression identified key diagnostic features, and 11 machine learning models were developed and compared.
RESULTS
The CBA group showed higher levels of total bile acid, total bilirubin, γ-glutamyl transferase, aspartate aminotransferase, and alanine aminotransferase, and direct bilirubin, while longitudinal diameter of the cysts and transverse diameter of the cysts were larger in the CC group. The multilayer perceptron model demonstrated optimal performance with 95.8% accuracy, 92.9% sensitivity, 96.3% specificity, and an area under the curve of 0.990. Decision curve analysis confirmed its clinical utility. Based on the model, we developed user-friendly diagnostic software for clinical implementation.
CONCLUSION
Our machine learning approach differentiates CC from CBA in early infancy using routinely available clinical parameters. Early accurate diagnosis facilitates timely surgical intervention for CBA cases, potentially improving patient outcomes.
Core Tip: This study developed a multilayer perceptron diagnostic model for early postnatal differentiation between choledochal cysts and cystic biliary atresia (CBA). The model, incorporating selected biochemical markers and ultrasonographic features, demonstrates exceptional diagnostic accuracy (95.8%), an area under the curve of 99.0%, and significant clinical utility. We transformed this model into user-friendly diagnostic software for convenient clinical application, facilitating rapid decision-making that helps prevent delayed surgery in CBA patients. This approach potentially improves long-term outcomes by enabling timely intervention during the critical early postnatal period when distinguishing between these conditions is most challenging but therapeutically crucial.
