title: Differentiating Simple Hepatic Cysts from Mucinous Cystic Neoplasms: Radiological Features, Cyst Fluid Tumour Marker Analysis and Multidisciplinary Team Outcomes.
abstract: BACKGROUND
  Differentiating hepatic mucinous cystic neoplasms (MCNs) from simple hepatic cysts (SCs) preoperatively is a challenging task. Our aim was to determine whether radiological features on ultrasound scan (USS), CT or MRI, cyst fluid tumour markers, or multidisciplinary team (MDT) outcomes could differentiate MCN from SC.
  
  
  METHODS
  A retrospective review of radiological features, cyst fluid tumour marker levels and MDT outcomes in 52 patients was performed.
  
  
  RESULTS
  There were 13 patients with MCN, 38 with SC and one ciliated foregut cyst. MCNs were more often solitary (p = 0.006). Although no other individual radiological characteristic on USS, CT or MRI was predictive of MCN, MDT outcomes stating that a cyst was complex in nature were highly predictive (p = 0.0007). Cyst fluid carbohydrate antigen 19-9, carcino-embryonic antigen and cancer antigen 125 were unable to differentiate MCN from SC (p = 0.45, p = 0.49, and p = 0.73, respectively).
  
  
  CONCLUSIONS
  MDT outcomes are of greatest value when trying to differentiate MCN from SC, as well as having a solitary cyst on imaging. Conventional cyst fluid tumour markers are unhelpful. All suspicious cystic liver lesions should be discussed pre-operatively by a hepatobiliary MDT to determine the most appropriate surgical approach.
authors.affiliation: Department of HPB Surgery, Derriford Hospital, Plymouth, UK.
authors.forename: Peter Lawrence Zaki
authors.initials: PL
authors.lastname: Labib
authors.forename: Somaiah
authors.initials: S
authors.lastname: Aroori
authors.forename: Matthew
authors.initials: M
authors.lastname: Bowles
authors.forename: David
authors.initials: D
authors.lastname: Stell
authors.forename: Christopher
authors.initials: C
authors.lastname: Briggs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000032:analysis; D018395:CA-19-9 Antigen / Q000032:analysis; D003560:Cysts / Q000737:chemistry* / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging* / Q000601:surgery; D010348:Patient Care Team; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D018394:CA-125 Antigen; D018395:CA-19-9 Antigen