Radiologic-Pathologic Correlation in Biliary Cystic Neoplasms: Insights From a Single-Centre Experience

Area of Science:

• Hepatobiliary Medicine
• Gastroenterology
• Radiology

Background:

• Biliary cystic neoplasms (BCNs), including biliary cystadenomas (BCAs) and cystadenocarcinomas (BCACs), are rare liver and biliary tract tumors.
• Preoperative differentiation between benign and malignant BCNs is challenging due to limitations in current imaging criteria.

Purpose of the Study:

• To correlate preoperative imaging features with final histology in BCNs.
• To identify radiologic markers for malignancy in BCNs.

Main Methods:

• Retrospective analysis of 42 histologically confirmed BCN cases (2010-2023).
• Review of preoperative cross-sectional imaging (CT/MRI/MRCP) for features like wall enhancement, septations, mural nodules, calcification, and fluid complexity.
• Histological categorization into low-grade dysplasia (LGD), high-grade dysplasia (HGD), or invasive carcinoma (BCAC).

Main Results:

• Wall enhancement was more frequent in advanced histology (67%) versus LGD (28%).
• Thick fluid density correlated with advanced pathology (33% vs. 8%).
• Mural nodules were only found in LGD cases, not in HGD or BCAC.

Conclusions:

• Wall enhancement and complex fluid are suggestive of advanced BCN but have limited diagnostic accuracy due to overlap with benign lesions.
• Mural nodules were not predictive of malignancy in this cohort.
• Surgical resection of complex or atypical cystic liver lesions is recommended; multidisciplinary consensus and histologic evaluation are crucial for diagnosis.