Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abdom Radiol (NY). 2022 Apr;47(4):1333-1340. doi: 10.1007/s00261-022-03436-1. Epub 2022 Feb 21.
Preoperative radiographic differentiation of mucinous cystic neoplasms (MCN) and simple cysts (SLC) of the liver is challenging. Previous data have demonstrated that the finding of septations arising from the cyst wall without indentation on cross-sectional imaging is associated with MCN. We aim to assess whether this radiographic feature is diagnostic of MCN.
A prospectively maintained database was queried for patients with a preoperative diagnosis of a cystic liver lesion who subsequently underwent operative intervention. The feature of septations without indentation of the cyst wall was evaluated on cross-sectional imaging obtained within 3 months of operation. Imaging was independently evaluated by three radiologists blinded to pathology and interobserver agreement was compared to assess the diagnostic accuracy of this feature as well as the overall likelihood of the lesion representing a MCN.
There were 95 patients who met inclusion criteria; 80 (84%) had SLC on pathology, while 15 (16%) had MCN. Presence of septa without indentation of cyst wall had high sensitivity (range 80-87%), but low specificity (range 48-66%). Interobserver percent agreement (PA) was 51% [κ = 0.35 (95% CI 0.22-0.47)]. Sensitivity among the three radiologists ranged between 20 and 80% and specificity between 71 and 91% for the likelihood of the lesion representing MCN versus SLC, with an area under the curve (AUC) of 0.67-0.79; however, interobserver agreement was fair [κ = 0.40 (95% CI 0.25-0.55), PA = 67%].
The presence of septations without indentation of cyst wall demonstrates adequate sensitivity to differentiate MCN and SLC. However, there is variability for detection of this feature and therefore, it alone is of limited clinical value.
术前鉴别肝黏液性囊性肿瘤（MCN）和单纯性囊肿（SLC）具有挑战性。先前的数据表明，在横断面成像上发现从囊肿壁延伸出的分隔而无凹陷与 MCN 相关。我们旨在评估该影像学特征是否对 MCN 具有诊断价值。
通过前瞻性维护的数据库，对术前诊断为囊性肝病变且随后接受手术干预的患者进行了查询。在手术前 3 个月内获得的横断面成像上评估无囊肿壁凹陷的分隔特征。三位放射科医师对影像学进行独立评估，对病理结果不知情，并比较了观察者间的一致性，以评估该特征的诊断准确性以及病变代表 MCN 的总体可能性。
共有 95 名符合纳入标准的患者；80 名（84%）患者的病理结果为 SLC，15 名（16%）患者为 MCN。存在无囊肿壁凹陷的分隔具有较高的敏感性（范围为 80%-87%），但特异性较低（范围为 48%-66%）。观察者间的百分比一致率（PA）为 51%[κ=0.35（95%CI 0.22-0.47)]。三位放射科医师的敏感性范围为 20%-80%，特异性范围为 71%-91%，用于评估病变代表 MCN 与 SLC 的可能性，曲线下面积（AUC）为 0.67-0.79；然而，观察者间的一致性为中等[κ=0.40（95%CI 0.25-0.55），PA=67%]。
无囊肿壁凹陷的分隔的存在具有足够的敏感性来区分 MCN 和 SLC。然而，对于该特征的检测存在变异性，因此，其单独的临床价值有限。
