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Diagnosis and treatment of hepatic cysts. Usefulness of intracystic tumor markers (CEA and CA 19.9.)
Diagnóstico y tratamiento de los quistes hepáticos. Utilidad de los marcadores tumorales intraquísticos (CEA y CA 19.9.)
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Usefulness of intracystic tumor markers (CEA and CA 19.9.)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "19" "paginaFinal" => "24" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Daniela Polette, Kristel Mils, Fina López-Domínguez, Oriana Barrios, David Leiva, Isabel Puig, Emilio Ramos, Laura Lladó" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Daniela" "apellidos" => "Polette" "email" => array:1 [ 0 => "dpolette@bellvitgehospital.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Kristel" "apellidos" => "Mils" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Fina" "apellidos" => "López-Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Oriana" "apellidos" => "Barrios" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "David" "apellidos" => "Leiva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Isabel" "apellidos" => "Puig" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Emilio" "apellidos" => "Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Laura" "apellidos" => "Lladó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Radiología Hepatobiliopancreática, Hospital Universitario de Bellvitge, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico y tratamiento de los quistes hepáticos. Utilidad de los marcadores tumorales intraquísticos (CEA y CA 19.9.)" ] ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 754 "Ancho" => 1333 "Tamanyo" => 156633 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Simple hepatic cysts (SHCs) are derived from congenital exclusions of hyperplastic bile duct remnants with no communication with the bile duct. They are usually asymptomatic and are diagnosed incidentally, although they may occasionally cause symptoms such as abdominal pain or bloating, postprandial fullness, dyspnoea, and less common symptoms secondary to infection, perforation, or intracystic bleeding.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">With the increased use of imaging in recent years, the incidental diagnosis of cystic liver lesions has also increased.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The incidence of SHC in the general population ranges from 15%–20%. For patients with symptomatic SHC the incidence of premalignant or neoplastic lesions can be as high as 5%.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The differential diagnosis of cystic liver lesions is complex; sometimes it can be very difficult to differentiate a simple cyst from premalignant liver lesions such as cystic mucinous neoplasia (CMN) and intraductal papillary neoplasm of the bile duct (IPNB).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> The differential diagnosis of cystic lesions is made by imaging tests such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). It can sometimes be difficult to distinguish the type of lesion by imaging alone as these types of lesions do not have pathognomonic features.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A lack of radiological correlation may lead to unnecessary surgery.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Therefore, further data would be interesting to enable a correct differential diagnosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The usefulness of tumour marker values (TM) obtained from the fluid of pancreatic cystic lesions to differentiate benign from premalignant or malignant pancreatic lesions has been demonstrated in recent years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Therefore, extrapolating this hypothesis to cystic liver lesions, recent attempts have been made to correlate intracystic TM values with the ability to differentiate benign cystic liver lesions from premalignant lesions.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> Some studies suggest that cystic lesions with elevated intracystic carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19.9 may be premalignant lesions while, conversely, simple cystic lesions tend to have normal TM values.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study is to review our experience in the diagnostic and therapeutic management of symptomatic simple cysts. Specifically, we discuss the usefulness of intracystic CEA and CA19.9 testing for the differential diagnosis between simple liver cyst and premalignant or malignant cystic liver lesions.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A retrospective analysis of our prospective database of patients treated at our centre for symptomatic SHC from January 2003 to December 2021 was performed. Patients with non-symptomatic SHC for whom no treatment was indicated are not included in the study, as they were not prospectively collected. Patients with suspected or preoperative confirmation of cystic mucinous neoplasms of the liver (CMN) were excluded, as their management would now be different.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Briefly, in cases of SCH presenting with symptoms, surgical fenestration is indicated as the first treatment of choice. In cases with non-specific symptoms, or cases of advanced age and/or comorbidity, percutaneous drainage with alcohol sclerotherapy is indicated as the first therapeutic action. In patients with clinical and radiological recurrence after drainage, the surgical option is re-evaluated, age and comorbidity permitting.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Diagnosis was based on the radiological study performed with ultrasound and/or computed tomography, or magnetic resonance imaging. Levels of intracystic tumour markers (CEA and CA 19.9) were determined intraoperatively or from contents obtained during percutaneous puncture. The previously described cut-off points of CEA > 30 μg/L and CA 19.9 15000 U/mL<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> were considered risk criteria for CMN.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The variables studied were demographic characteristics, symptoms, imaging tests performed, treatment and progression during follow-up.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data were collected in a Microsoft Office Access database and processed using SPSS. A descriptive statistical analysis of the results was performed.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fifty patients with an initial diagnosis of SHC requiring symptom-specific treatment were included. Most patients were female (70%), with a median age of 64 years, and with a median Charlson index of 5.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The most common symptom was abdominal pain (35/50; 70%), followed by oral intolerance and postprandial fullness (2/50; 4%), other less frequent symptoms such as infection and jaundice occurred in only one patient, respectively. Symptoms were non-specific in 18% of patients.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding cyst characteristics, the most frequent was the single cyst in 46%, 24% of patients had fewer than 5 cysts, while 30% had more than 5 cysts. The median size was 13 cm [2–22] and the most common cyst type was simple cyst in 60%, complex in 24% (12/50). Median follow-up was 36 months [11–144].</p><p id="par0075" class="elsevierStylePara elsevierViewall">Diagnostic tests performed were ultrasound (83%), CT (88%), MRI (55%), and cytology for pathology (81%). Intracystic tumour markers were detected in 41 patients (77%).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Intracystic TM values showed great variability (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The median CA 19.9 was 227,321 U/mL [.6–1183570], while the median CEA was 196 μg/L [0.2–740]. The TM values of the patients with pathological anatomy other than simple cyst, we only had values from two of the four patients, are marked in red in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The patient with a diagnosis of B-cell lymphoma had a CEA of 1.8 μg/L and CA 19.9 of 222 U/mL. One of the patients with pathological anatomy of CMN had a CEA of 27.8 μg/L and CA 19.9 of 224 U/mL.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Fifty-one percent of the patients with SHC tested for CA 19.9 above the cut-off point of 15000 U/mL and 59% had CEA above 30 μg00/L. This reflects a positive predictive value (PPV) of 0% for both TMs and a negative predictive value (NPV) of 89% and 91% respectively.</p><p id="par0090" class="elsevierStylePara elsevierViewall">All 50 patients studied in our series underwent treatment for symptom onset (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Conservative treatment with drainage and percutaneous sclerotherapy was indicated in 15 patients and was effective in only three. Of the patients in whom it was not effective (12/15), surgery was indicated as a second treatment in three, a watchful waiting approach was decided in one patient due to few symptoms, and eight patients underwent a second drainage and sclerotherapy. The four patients whose symptoms persisted underwent surgery, which was effective as a third treatment, and two patients required a third drainage without resolution, therefore, one patient underwent successful surgery, and a watchful waiting approach was decided in the second patient due to comorbidities.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Surgical fenestration was indicated as the first treatment in 35 patients, and was successful in most of them (29/35; 82.8%). Of the six patients in whom surgery failed, one patient required percutaneous drainage due to recurrence of symptoms and in two patients watchful waiting was decided due to improvement of symptoms. In three patients a second surgery was indicated because of the pathological anatomy of the cyst wall. Given the clinical course, none of the patients with sclerotherapy who did not undergo surgery were considered to have a cystic neoplasm.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In three patients, a second surgery was indicated due to pathological diagnosis of the cyst wall; in two patients the diagnosis was of CMN and therefore enucleation was indicated in one patient and a right hepatectomy in the second, these procedures were indicated according to the location of the lesions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A third patient required a liver transplant due to a diagnosis of IPNB and multifocal involvement, and vascular contacts. All three patients progressed well without complications in the postoperative period or during follow-up. The remaining anatomopathological findings reported simple cyst in 40 cases and one patient was diagnosed with lymphoma. The latter patient was evaluated by the haematology service; she was diagnosed with fibrin-associated large B-cell lymphoma, an entity with a good prognosis and, as it was a chance finding, she did not require any treatment, just continued monitoring.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The diagnosis and management of cystic liver lesions is established in different clinical guidelines.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Treatment is indicated if symptoms are present or if malignancy is suspected. However, the differential diagnosis between simple liver cyst and premalignant or malignant hepatic cystic lesion (CMN or IPNB) is complex. Recently, there have been reports of over-diagnosis of suspected CMN, leading to unnecessary surgery.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> A correct preoperative diagnosis is necessary for the correct therapeutic indication.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Once a diagnosis of symptomatic SHC has been confirmed, treatment will be tailored to the patient's characteristics. Drainage or aspiration of the cyst is generally not recommended due to the high recurrence rate. The recommended treatment of choice is surgery whenever possible. If there is no suspicion of malignancy and surgery is only indicated due to symptoms, laparoscopic fenestration is indicated. However, if surgery is indicated due to suspicion of malignancy, complete excision of the cyst is recommended.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> For complete excision, enucleation is indicated whenever possible; in some cases, hepatectomy or even liver transplantation may be necessary.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">However, it is not always easy to indicate the correct treatment, because given the non-specific symptoms in these patients it may be difficult to indicate surgical treatment without being able to offer certainty of symptom remission. Therefore, in our centre recommended initial treatment is surgical fenestration in young, operable patients with specific symptoms related to the liver cyst. On the other hand, in older patients with comorbidities or if there are doubts that the cysts are really symptomatic, percutaneous treatment with drainage or sclerotherapy is decided.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Radiological techniques cannot conclusively differentiate between a simple cyst and a premalignant cystic lesion.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> The anatomopathological study of the cyst wall after fenestration enables a correct diagnosis, which would indicate surgical reintervention in cases of hepatic cystic neoplasia. However, a test that allows the diagnosis to be accurately established preoperatively would be of great interest. With this aim of improving radiological reliability, algorithms have recently been developed that can improve diagnostic reliability.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Another line of study is the determination of intracystic TMs.</p><p id="par0125" class="elsevierStylePara elsevierViewall">From a pathological and immunohistochemical perspective, premalignant pancreatic and hepatic cystic lesions have many common features.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> While in the management of pancreatic cystic lesions testing for intracystic CEA has a role in the differential diagnosis, its usefulness in the management of hepatic cystic lesions has not been clearly established. Fuks et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> studied this relationship with a sample size of 118 patients, including simple cysts and hepatic cystic tumours. No significant differences were found for Ca19.9 and CEA TMs, however, they defined cut-off points above which suspicion of malignant cystic mucinous lesions could be increased with very low sensitivity and specificity.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Considering the cut-off point proposed by Fuks et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> we observed that up to 60% of the patients in our series with SHC had CA 19.9 above the reference value, and 54% exceeded the reference value as pathological CEA. When reviewing patients with elevated TMs (CA 19.9 > 250000 μg/L and CEA > 300 U/mL) we confirmed that the pathological anatomy was diagnostic of SHC in all of them. In contrast, the MKT values of the two patients with premalignant lesions were below the established cut-off values. Thus, in our experience TM testing does not seem to be useful in the differential diagnosis of cystic liver lesions.</p><p id="par0135" class="elsevierStylePara elsevierViewall">A third tumour marker has been described that is associated with different types of tumours, namely tumour associated glycoprotein 72 (TAG72). Ouyang et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> studied TAG72 as a prognostic factor in relation to gallbladder neoplasia, concluding that TAG72 is not present in normal biliary cells and that the presence of this TM in patients with gallbladder tumours may be a clinicopathological criterion of aggressiveness. Following these findings, Fuks et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> studied the relationship between TAG72 and cystic lesions of the liver and concluded that most patients with mucinous cysts expressed elevated TAG72 (26/27) compared to patients with simple cysts (12/75). Thus, it seems that this marker could be useful. However, in our case it could not be analysed as it is not possible to test for it in our centre</p><p id="par0140" class="elsevierStylePara elsevierViewall">Assessing the results of the treatments performed in our series, we agree with that described previously, because the most effective treatment in our experience was surgery, with an efficacy rate of up to 87%, compared to 23% for simple drainage or sclerotherapy.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The review of our experience shows the low efficacy of percutaneous drainage and sclerotherapy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The most effective treatment for symptomatic simple hepatic cysts is laparoscopic fenestration with low morbidity and mortality and recurrence. Given the high recurrence rate, we believe that drainage with sclerotherapy should be reserved for improving symptoms in patients who are not optimal for surgery.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Our work offers a description of the diagnosis and treatment of symptomatic simple cysts. However, it has a number of limitations, firstly, the limited number of cases, especially considering the low frequency of CMN. The selection of symptomatic SHC may be a selection bias; however, we focused on these cases as this is the most frequent clinical scenario. As the study is a retrospective analysis of a prospective database, not all patients were studied equally, and tumour marker testing is not available in all cases. The loss of long-term follow-up is another limitation to be considered. Finally, as mentioned above, although TAG72 seems to be a useful marker, we cannot test for it in our centre.</p><p id="par0155" class="elsevierStylePara elsevierViewall">However, the scarcity of published literature is noteworthy, and therefore this study may be useful to provide more information on the management of cystic liver disease in our setting and constitute a first step for future studies. Future studies should perhaps be based on the search for new intracystic markers.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion, intracystic CEA and CA 19−9 tumour marker values do not enable us to distinguish simple cysts from hepatic cystic neoplasms due to their null positive predictive value.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The diagnosis of cystic lesions, especially if there is suspicion of malignancy, should not be based solely on one diagnostic test but on a combination of them, and the review of individual cases in a multidisciplinary committee.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2077992" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres2077990" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1772828" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres2077991" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1772827" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-24" "fechaAceptado" => "2023-08-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1772828" "palabras" => array:5 [ 0 => "Hepatic cyst" 1 => "Simple cyst" 2 => "Tumour markers" 3 => "Mucinous cystic neoplasms of the liver" 4 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1772827" "palabras" => array:5 [ 0 => "Quiste hepático" 1 => "Quiste simple" 2 => "Marcadores tumorales" 3 => "Neoplasia mucinosa hepática" 4 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To decide treatment of hepatic cysts diagnosis between simple hepatic cyst (SHC) and cystic mucinous neoplasm (CMN). Radiological features are not patognomonic. Some studies have suggested the utility of intracystic tumor markers.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of our prospective database including patients treated due to symptomatic SHC from 2003 to 2021. The aim of the study was to evaluate the results of treatment of symptomatic SHC and the usefulness of the determination of intracystic “carcinoembryonic antigen” (CEA) and “carbohydrate antigen” CA 19.9.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">50 patients diagnosed and treated for symptomatic SHC were included. In 15 patients the first treatment was percutaneous drainage. In 35 patients the first treatment was laparoscopic fenestration. Four patients were diagnosed of premalignant or malignant liver cystic lesions (MCN, IPMN, lymphoma B); three of them required surgery after initial fenestration and pathological diagnosis.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Median CEA and CA 19−9 were 196 μg/L and 227.321 U/mL respectively. Patients with malignant or premalignant pathology did not have higher levels of intracystic tumor markers. Positive predictive value was 0% for both markers, and negative predictive value was 89% and 91% respectively.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Values of intracystic tumor markers CEA and CA 19−9 do not allow distinguishing simple cysts from cystic liver neoplasms. The most effective treatment for symptomatic simple liver cysts is surgical fenestration. The pathological analysis of the wall of the cysts enables the correct diagnosis, allowing to indicate a surgical reintervention in cases of hepatic cyst neoplasia.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El tratamiento de los quistes hepáticos requiere del diagnóstico diferencial de quiste simple hepático (QSH) de la neoplasia mucinosa quística (NMQ) hepática. Las características radiológicas no son patognomónicas. Algunos estudios han sugerido la utilidad de los marcadores tumorales (MKT) intraquísticos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de base de datos prospectiva incluyendo pacientes diagnosticados de QSH sintomático desde el 2003 hasta el 2021. El objetivo del estudio es evaluar los resultados del tratamiento de los QSH sintomáticos y analizar la utilidad de la determinación de “carcinoembryonic antigen” (CEA) y “carbohydrate antigen” CA 19.9 intraquísticos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 50 pacientes tratados por quiste sintomático. En 15 pacientes el primer tratamiento fue el drenaje percutáneo. En 35 pacientes se realizó fenestración laparoscópica. Cuatro pacientes se diagnosticaron de lesiones premalignas/malignas (NMQ, NPIB, linfoma B); tres de ellos requirieron una segunda cirugía tras la fenestración y el diagnóstico anatomopatólogo.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La mediana de los valores de CEA y CA- 19.9 fue de 196 μg/L y 227.321U/mL respectivamente. Los pacientes con lesiones premalignas no tuvieron valores elevados de MKT. El valor predictivo positivo fue del 0% en ambos MKT, y el valor predictivo negativo fue de 89% y 91% respectivamente.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Los valores de CEA y CA 19.9 intraquísticos no permiten distinguir los QSH de las NMH. El tratamiento más resolutivo de los QSH sintomáticos es la fenestración quirúrgica. El análisis anatomopatológico de la pared del quiste posibilita su correcto diagnóstico, permitiendo indicar una reintervención quirúrgica en los casos de NMQ.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1815 "Ancho" => 3341 "Tamanyo" => 395060 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0190" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intracystic CA 19.9 and CEA tumour marker values. Patients with remalignant/malignant pathology are marked in bold.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1901 "Ancho" => 3341 "Tamanyo" => 317190 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0195" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Treatment of symptomatic simple hepatic cysts.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1355 "Ancho" => 3341 "Tamanyo" => 363816 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0200" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CT images of patients with hepatic cyst undergoing laparoscopic fenestration. (a) Case of CMN (second stage right hepatectomy). (b) Case of IPNB (second stage liver transplantation.).</p>" ] ] 3 => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 754 "Ancho" => 1333 "Tamanyo" => 156633 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Americal College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Marrero" 1 => "J. Ahn" 2 => "K. 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