Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12595
Revised: May 19, 2014
Accepted: June 14, 2014
Published online: September 21, 2014
AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma.
METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up.
RESULTS: Preoperative levels of cancer antigen 125 (12.51 ± 9.31 vs 23.20 ± 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 ± 26.30 vs 72.55 ± 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications.
CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results.
Core tip: The number of females was larger than that of males in both groups. Carbohydrate antigen 19-9 has important significance in the preoperative diagnosis of intrahepatic biliary cystadenoma and cystadenocarcinoma. About half of the patients had elevated levels of total bilirubin (TBIL) and direct bilirubin (DBIL); therefore, we believe it is necessary to test TBIL and DBIL before surgery. The diagnosis relies on the integration of information consisting of clinical symptoms, laboratory findings and imaging results. The short-term and long-term prognoses of cystadenoma were better than those for cystadenocarcinoma.