Role of ultrasonography in evaluation of obstructive jaundice

Abstract

Objective: To evaluate the sensitivity, specificity and accuracy of Ultrasonography in assessing the level and causes of obstruction in patients with obstructive jaundice.

Materials and Methods: A total of 45 patients with clinical and laboratory features of biliary obstruction were included for statistical analysis. All these patients were evaluated with ultrasonography (USG). The levels of biliary obstruction were grouped as hilar, suprapancreatic and intra-pancreatic. Similarly, the probable causes were grouped as malignant or benign. Findings of USG were corroborated with cholangiographic, per-operative and/or histopathological findings (FNAC/Biopsy).

Results: Most of the patients were in the age group of 61-80 years. There were 24 females (53%) and 21 males (47%). Accuracy of USG in identification of hilar, suprapancreatic and intrapancretic level of obstruction was 95.5%, 88.8% and 86.6%, respectively. Sensitivity and Specificity of USG in identifying the hilar level of obstruction was 91.6% and 93.9%, respectively. Similarly, sensitivity of USG in identifying the supra-pancreatic level of obstruction was 88.88% and specificity was 88.88%. At the intrapancreatic level sensitivity was 83.33% and specificity was 90.47%. Benign causes were seen in 53% and malignant causes in 47% of patients. Accuracy rate of USG in identifying the cause of obstruction was 82.2%. Choledocholithiasis was the commonest cause for obstruction seen in 48.4% of patients. Carcinoma head of pancreas and cholangiocarcinoma were common malignant causes of obstruction (13.3%). Sensitivity of USG in detecting malignant biliary obstruction was 80.95% and specificity was 83.33%.

Conclusion: Overall accuracy, sensitivity and specificity of USG in identification of hilar level of obstruction were higher than suprapancreatic and intrapancreatic levels..