The accuracy of pre-operative imaging in the management of hepatic cysts. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Doussot, Alexandre; Gluskin, Jill; Groot-Koerkamp, Bas; Allen, Peter J.; De Matteo, Ronald P.; Shia, Jinru; Kingham, T. Peter; Jarnagin, William R.; Gerst, Scott R.; D'Angelica, Michael I.
• Is Part Of: HPB. Volume 17:Issue 10(2015:Oct.)
• Page Start: 889
• Page End: 895
• Publication Date: 2015-10
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12443
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: 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.