![]() Pancreatic cystic lesions (PCL) are being detected with increasing frequency because of the widespread use of cross-sectional imaging. Newer markers to improve diagnostic accuracy are on the horizon, but clinical studies are awaited. Cytology is especially helpful in diagnosing malignancy typically in the presence of a solid component in the cyst. The presence of a KRAS mutation is very specific for a mucinous cyst but lacks sensitivity. Approximately 0.2 to 1.0 mL of cyst fluid is required to run the test and a cut-off of 192 ng/ mL can be expected to capture ~75% of mucinous cysts. Pancreatic cyst CEA level is considered the most accurate tumor marker for diagnosing mucinous cysts. Cyst fluid can be analyzed for tumor markers, cytology, mucins, DNA analysis and amylase. The current diagnostic evaluation of PCL often includes EUS-guided fine needle aspiration (EUS-FNA) for cyst fluid analysis. The difficulty in identifying the various PCL and their unpredictable potential for malignant degeneration makes their management cumbersome. These represent a wide variety of lesions including mucinous cysts that have malignant potential. Pancreatic cystic lesions (PCL) may be incidentally detected in up to 13.5% of patients. ![]()
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