Nomogram to predict the risk of endoscopic removal failure with forceps/baskets for treating submandibular stones

doi:10.12998/wjcc.v10.i9.2710

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World Journal of Clinical Cases

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Retrospective Cohort Study

World J Clin Cases. Mar 26, 2022; 10(9): 2710-2720
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2710

Nomogram to predict the risk of endoscopic removal failure with forceps/baskets for treating submandibular stones

Yun Huang, Pei-Sheng Liang, Yao-Cheng Yang, Wei-Xin Cai, Qian Tao

Yun Huang, Pei-Sheng Liang, Yao-Cheng Yang, Wei-Xin Cai, Qian Tao, Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou 510055, Guangdong Province, China

Yun Huang, Pei-Sheng Liang, Yao-Cheng Yang, Wei-Xin Cai, Qian Tao, Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China

Author contributions: Tao Q and Huang Y designed the study; Huang Y, Liang PS, Yang YC and Cai WX performed the research; Huang Y, Liang PS and Yang YC contributed the analytic tools; Huang Y, Liang PS and Yang YC analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.

Supported by Guangdong Basic and Applied Basic Research Foundation, No. 2019A1515012139.

Institutional review board statement: The study was approved by the Medical Ethics Committee of Hospital of Stomatology, Sun Yat-Sen University (No. KQEC-2019-41).

Informed consent statement: Informed consent was obtained from the patient for the publication of images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.

Data sharing statement: Statistical code and dataset are available from the corresponding author at taoqian@mail.sysu.edu.cn.

STROBE statement: All the authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Qian Tao, MD, PhD, Chief Doctor, Professor, Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, No. 56 Lingyuanxi Road, Guangzhou 510055, Guangdong Province, China. taoqian@mail.sysu.edu.cn

Received: August 24, 2021
Peer-review started: August 24, 2021
First decision: November 17, 2021
Revised: November 26, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: March 26, 2022
Processing time: 210 Days and 1.5 Hours

Abstract

BACKGROUND

Endoscopic removal with forceps/baskets is favored in treating submandibular stones due to its minimal invasiveness. However, recent studies have found that endoscopic removal failure (ERF) is not unusual, and stones in such cases still need to be removed with other surgical methods. If the risk of ERF can be predicted preoperatively, it could be helpful for surgeons when choosing the appropriate therapy.

AIM

To develop a predictive nomogram for the risk of ERF when treating submandibular stones based on their preoperative clinical features.

METHODS

A total of 180 patients with 211 submandibular stones treated from January 2012 to December 2020 were included in the current study. Based on the preoperative clinical features of the stones, independent risk factors for ERF were identified by logistic regression analysis. The stones were then randomly divided into training and testing sets. A nomogram was constructed to predict the risk of ERF using the training set and then validated using both sets. The predictive performance of the nomogram was assessed by calibration curves and the concordance index (C-index).

RESULTS

Three independent predictors, location (P = 0.040), transverse diameter (P < 0.001) and longitudinal diameter (P < 0.001) measured on the cone beam computed tomography (CBCT) images of the submandibular stones, were identified and included in the predictive nomogram. Calibration curves of the nomogram showed good agreement between the predicted and observed probabilities in both sets. The C-index in the training set was 0.917 (95%CI, 0.875-0.959) and that in the testing set was 0.925 (95%CI, 0.862-0.989).

CONCLUSION

A nomogram based on the location, transverse and longitudinal diameters on CBCT images of submandibular stones showed satisfactory efficacy in predicting the risk of ERF preoperatively when treating submandibular stones.

Keywords: Endoscopic removal failure; Submandibular stones; Cone beam computed tomography; Location; Diameter; Nomogram

Core Tip: A predictive nomogram based on the objective and measurable preoperative clinical features of submandibular stones was constructed in the present study; the nomogram helps to determine the risk of endoscopic removal failure preoperatively and aids in the selection of appropriate surgical methods.