Intrahepatic biliary cystadenoma: role of cyst fluid analysis and surgical management in the laparoscopic era.
BACKGROUND
Recent interest in cyst fluid analysis (CFA) for carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), and the introduction of laparoscopic surgery (LS) in the management of hepatic cysts have resulted in sporadic reports of elevated CA 19-9 and CEA levels in intrahepatic biliary cystadenoma (IBC) CFA, and the application of LS in the management of simple cysts. However, the role of CA 19-9 and CEA in the diagnosis of IBC and the role of LS in the management of IBC have not been previously defined.


METHODS
We studied 34 patients with IBC at a single institution (8 years). The first 12 patients with IBC were managed with open surgical intervention. We subsequently developed a diagnostic and treatment algorithm for IBC that included, in the last 22 patients, prospective analysis of CFA for CA 19-9 and CEA, and LS for management


RESULTS
All patients with IBC who underwent CFA had elevated CA 19-9 (range, 2247-1,757,510; N <33 U/mL) and mildly elevated CEA (range, 3.3-212,; N <3 ng/ml). In all 22 patients the cyst lining consisted of biliary epithelium +/- mesenchymal stroma (MS). In 1/22 patients (highest CA 19-9 level), the cyst epithelium did not contain either MS or intestinal metaplasia. In contrast, control patients (simple cysts, n=8) had normal CFA. In the previous 12 patients managed with laparotomy, 6/12 patients had biliary epithelium alone; the other 6 also contained MS with 1 patient exhibiting intestinal metaplasia and cystadenocarcinoma.


CONCLUSIONS
We have proposed a management algorithm for IBC that incorporates CFA and laproscopic surgical management that allows for selective minimally invasive cyst wall sampling for patients with IBC.
Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
Alan
A
Koffron
Sambasiva
S
Rao
Mario
M
Ferrario
Michael
M
Abecassis
D000465:Algorithms; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D018395:CA-19-9 Antigen / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002780:Cholestasis, Intrahepatic / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D003537:Cystadenoma / Q000473:pathology* / Q000601:surgery*; D003581:Cytodiagnosis; D005122:Exudates and Transudates / Q000166:cytology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen