The accuracy of pre-operative imaging in the management of hepatic cysts Journal Article
| Authors: | Doussot, A.; Gluskin, J.; Groot Koerkamp, B.; Allen, P. J.; De Matteo, R. P.; Shia, J.; Kingham, T. P.; Jarnagin, W. R.; Gerst, S. R.; D'Angelica, M. I. |
| Article Title: | The accuracy of pre-operative imaging in the management of hepatic cysts |
| 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. © 2015 International Hepato-Pancreato-Biliary Association. |
| Journal Title: | HPB |
| Volume: | 17 |
| Issue: | 10 |
| ISSN: | 1365-182X |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2015-10-01 |
| Start Page: | 889 |
| End Page: | 895 |
| Language: | English |
| DOI: | 10.1111/hpb.12443 |
| PROVIDER: | scopus |
| PUBMED: | 26227923 |
| PMCID: | PMC4571756 |
| DOI/URL: | |
| Notes: | Export Date: 2 October 2015 -- Source: Scopus |
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