The impact of imaging on the surgical management of biliary cystadenomas and cystadenocarcinomas; a systematic review

HPB (Oxford). 2019 Oct;21(10):1257-1267. doi: 10.1016/j.hpb.2019.04.004. Epub 2019 May 10.

Abstract

Background: Biliary Cystadenomas (BCA) are considered to be benign but may transform to Biliary Cystadenocarcinomas (BCAC). The aim of this systematic review was to assess the diagnostic work-up and necessity of complete surgical resection.

Method: A systematic literature search was performed in Embase.com, Medline (Ovid), Cochrane Central, Web-of-Science and Google Scholar. Articles reporting on diagnostic work-up or outcome of various treatment strategies were included.

Results: Fifty-one articles with 1218 patients were included: 971 with BCA and 247 with BCAC. Patients with BCA were more often female (91% vs 63.8%, p < 0.001). On radiologic imaging BCAC more often had calcifications (p = 0.008), mural nodules (p < 0.001) and wall enhancement (p < 0.001). Reported treatment strategies were resection, enucleation, or fenestration/marsupialization. Recurrence was reported in 5.4% after resection for BCA and 4.8% after resection for BCAC. Recurrence after fenestration/marsupialization varied from 81.6% to 100% for both BCA as BCAC. Mortality rate was 0 in patients with BCA and 24% in BCAC.

Conclusion: Due to the difficulty in accurately diagnosing these biliary cystic lesions and the availability of different surgical approaches, patients with suspected BCA or BCAC should be treated in a center specialized in liver surgery with state-of-the-art imaging and all surgical techniques to prevent mismanagement of this rare disease.

Publication types

  • Systematic Review

MeSH terms

  • Bile Duct Neoplasms / diagnosis*
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Intrahepatic / diagnostic imaging*
  • Bile Ducts, Intrahepatic / surgery
  • Cystadenocarcinoma / diagnosis*
  • Cystadenocarcinoma / surgery
  • Cystadenoma / diagnosis*
  • Cystadenoma / surgery
  • Diagnosis, Differential
  • Hepatectomy / methods*
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Tomography, X-Ray Computed / methods*