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.
Koffron
Alan
A
Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
Rao
Sambasiva
S
Ferrario
Mario
M
Abecassis
Michael
M
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