Molecular markers contribute to the clinical diagnosis for pancreatic cystic neoplasms

Abstract

A pancreatic cystic neoplasm (PCN) is a rare pancreatic disease. Malignant PCNs are usually identified incidentally while evaluating other lesions. However, PCNs are being identified more frequently owing to the increased use of abdominal imaging. Malignant PCNs have complicated and diverse biological behaviors, including various malignant risk factors, diverse molecular features, natural history, and complex pathological classifications. Although many diagnostic methods, such as cross-sectional imaging and endoscopic evaluation, have been developed, malignant PCNs are still difficult to differentiate from benign tumors. On searching for related articles in the recent decade, we found that some molecular biomarkers such as carcinoembryonic antigen could be useful for discriminating between malignant tumors and benign tumors. However, cytopathologic evaluation is the most useful method for differentiating between benign and malignant lesions. Although cytopathologic evaluation has a specificity of 100% for identifying malignancies, its accuracy is often hampered by the low cellularity of PCN cells in the cystic fluid. Herein, we review the progress in the use of cellular and molecular markers for the accurate identification of PCNs.

A Practical Strategy to Reduce Surgical Overtreatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…A remarkable trend toward nextgeneration sequencing and other cyst fluid analysis has emerged in recent years to detect DNA, RNA, and protein molecular alterations in predefined panels to identify IPMNs at higher risk of malignant conversion with promising results. 4,5 There is also a notable emergence of serum biomarkers like circulating miRNA and ctDNA that could improve the prediction of IPMN malignant conversion in the future.…”

“…Computed tomography and magnetic resonance radiomics remain the most widely-adopted methods to assess the malignancy risk of IPMNs, following the International Association of Pancreatology/Fukuoka consensus, 3 supplemented by cyst fluid analysis, including cytology. A remarkable trend toward next-generation sequencing and other cyst fluid analysis has emerged in recent years to detect DNA, RNA, and protein molecular alterations in predefined panels to identify IPMNs at higher risk of malignant conversion with promising results 4,5 . There is also a notable emergence of serum biomarkers like circulating miRNA and ctDNA that could improve the prediction of IPMN malignant conversion in the future.…”