Models and algorithms for differential diagnosis of obstructive pathology of the common bile duct based on the results of endoscopic ultrasonography using hybrid fuzzy decision-making technologies

Objective: to improve the results of differential diagnosis of obstructive pathology of the common bile duct based on the results of endoscopic ultrasonography (EUS) using hybrid fuzzy decision-making technologies. Materials and methods. The study included 173 patients treated at the Kursk Regional Multidisciplinary Clinical Hospital in 2013-2023. Tumors of the common bile duct were detected in 24 (13.9%) patients, among whom 18 (75.0%) were women, 6 (25.0%) men, the exophytic type of cholangiocarcinoma prevailed, which was diagnosed in 13 (54.2%) patients, the infiltrative type was diagnosed in 11 (45.8%) patients. Benign obstruction of the common bile duct was diagnosed in 149 (86.1%) cases. In the vast majority of cases, choledocholithiasis was detected - 97 (65.1%) patients. Benign strictures of the common bile duct were found in 31 (20.8%) patients, among them cicatricial-inflammatory strictures of the terminal choledochus prevailed - 21 (67.7%) patients. Postoperative strictures were observed in 10 (32.3%) patients. Compression of the common bile duct by enlarged lymph nodes was diagnosed in 10 (6.7%) patients, Mirizzi Syndrome in 4 (2.7%) patients. Among the rare causes of impaired bile flow were cholangitis (4 people), biliodigestive fistulas (2 people), choledochus cyst (1 person). To solve poorly formalized problems of differential diagnosis of obstructive pathology of the common bile duct based on the analysis of endosonographic images at the Department of Biomedical Engineering of Southwestern State University, a flexible mathematical apparatus has been developed - a methodology for the synthesis of hybrid fuzzy decision rules used in this work. The mathematical apparatus integrates the intelligence of ultrasound diagnostics experts, a cognitive engineer and artificial intelligence. Results. Informative endosonographic criteria for the diagnosis of obstructive diseases of the common bile duct have been developed, systematized and presented in the form of reference images: reference endosonograms and their reference schemes, which fully reflect the characteristics of pathological changes. Based on the results of the expert assessment, the coefficients of confidence in the belonging of reference images to benign and malignant pathology, which are the basis of the diagnostic algorithm, were determined. The results of mathematical modeling have determined the confidence in the correct diagnosis of pathological conditions using synthesized fuzzy algorithms over 0.92, which is an acceptable result for clinical use. Conclusion. The systematization of informative EUS criteria for the differential diagnosis of obstructive diseases of the common bile duct, as well as the integration of fuzzy logic methods into the decision-making algorithm in this category of patients allows objectifying and improving the results of non-invasive EUS diagnostics, ensuring its effectiveness at a level not lower than 0.92.

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