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