Intrahepatic biliary cystadenoma: role of cyst fluid analysis and surgical management in the laparoscopic era

Surgery. 2004 Oct;136(4):926-36. doi: 10.1016/j.surg.2004.06.031.


Background: Recent interest in cyst fluid analysis (CFA) for carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), and the introduction of laparoscopic surgery (LS) in the management of hepatic cysts have resulted in sporadic reports of elevated CA 19-9 and CEA levels in intrahepatic biliary cystadenoma (IBC) CFA, and the application of LS in the management of simple cysts. However, the role of CA 19-9 and CEA in the diagnosis of IBC and the role of LS in the management of IBC have not been previously defined.

Methods: We studied 34 patients with IBC at a single institution (8 years). The first 12 patients with IBC were managed with open surgical intervention. We subsequently developed a diagnostic and treatment algorithm for IBC that included, in the last 22 patients, prospective analysis of CFA for CA 19-9 and CEA, and LS for management

Results: All patients with IBC who underwent CFA had elevated CA 19-9 (range, 2247-1,757,510; N <33 U/mL) and mildly elevated CEA (range, 3.3-212,; N <3 ng/ml). In all 22 patients the cyst lining consisted of biliary epithelium +/- mesenchymal stroma (MS). In 1/22 patients (highest CA 19-9 level), the cyst epithelium did not contain either MS or intestinal metaplasia. In contrast, control patients (simple cysts, n=8) had normal CFA. In the previous 12 patients managed with laparotomy, 6/12 patients had biliary epithelium alone; the other 6 also contained MS with 1 patient exhibiting intestinal metaplasia and cystadenocarcinoma.

Conclusions: We have proposed a management algorithm for IBC that incorporates CFA and laproscopic surgical management that allows for selective minimally invasive cyst wall sampling for patients with IBC.

MeSH terms

  • Algorithms
  • Bile Duct Neoplasms / pathology*
  • Bile Duct Neoplasms / surgery*
  • CA-19-9 Antigen / analysis
  • Carcinoembryonic Antigen / analysis
  • Cholestasis, Intrahepatic / pathology*
  • Cholestasis, Intrahepatic / surgery*
  • Cohort Studies
  • Cystadenoma / pathology*
  • Cystadenoma / surgery*
  • Cytodiagnosis
  • Exudates and Transudates / cytology
  • Humans
  • Laparoscopy / methods
  • Prospective Studies
  • Retrospective Studies


  • CA-19-9 Antigen
  • Carcinoembryonic Antigen