The accuracy of pre-operative imaging in the management of hepatic cysts.

Conference Paper

BACKGROUND: Biliary cystic tumours (BCT) [biliary cystadenoma (BCA) and cystadenocarcinoma (BCAC)] warrant complete resection. Simple liver cysts (SLC) require fenestration when symptomatic. Distinguishing between BCT and atypical SLC with pre-operative imaging is not well studied. METHODS: All patients undergoing surgery for a pre-operative suspected SLC or BCT between 1992 and 2014 were included. Peri-operative data were retrospectively reviewed. A blind radiological review of pre-operative imaging was performed. RESULTS: Ninety-four patients underwent fenestration (n = 54) or complete excision (n = 40). Final pathology was SLC (n = 74), BCA (n = 15), BCAC (n = 2) and other primary malignancies (n = 3). A frozen section (FS) was performed in 36 patients, impacting management in 10 (27.8%) by avoiding (n = 1) or mandating a liver resection (n = 9). Frozen section results were always concordant with final pathology. Upon blind review, a solitary lesion, suspicious intracystic component, septation and biliary dilatation were associated with BCT (P < 0.05). Diagnostic sensitivity was high (87.5-100%) but specificity was poor (43.1-53.4%). The diagnostic value of imaging was most accurate when negative for BCT (negative predictive value: 92.5-100%). CONCLUSION: Radiological assessment of hepatic cysts is relatively inaccurate as SLC frequently present with concerning features. In the absence of a strong suspicion of malignancy, fenestration and FS should be considered prior to a complete resection.

Full Text

Duke Authors

Cited Authors

  • Doussot, A; Gluskin, J; Groot-Koerkamp, B; Allen, PJ; De Matteo, RP; Shia, J; Kingham, TP; Jarnagin, WR; Gerst, SR; D'Angelica, MI

Published Date

  • October 2015

Published In

Volume / Issue

  • 17 / 10

Start / End Page

  • 889 - 895

PubMed ID

  • 26227923

Pubmed Central ID

  • PMC4571756

Electronic International Standard Serial Number (EISSN)

  • 1477-2574

Digital Object Identifier (DOI)

  • 10.1111/hpb.12443

Conference Location

  • England