Abstract
Pancreatic cystic neoplasms (PCN) comprise a diverse group of lesions with variable
malignant potential, requiring accurate diagnosis and risk stratification for appropriate
management. Distinguishing mucinous cysts, including intraductal papillary mucinous
neoplasms (IPMN) and mucinous cystic neoplasms (MCN), from benign nonmucinous lesions
such as serous cystadenomas (SCA) is essential due to their risk of progression to
invasive carcinoma. Importantly, IPMN and MCN represent the only radiologically detectable
precursors to pancreatic cancer, contributing to 15% of cases. Traditional diagnostic
approaches utilize imaging modalities like computed tomography, magnetic resonance
imaging, and endoscopic ultrasound (EUS), often supported by cyst fluid analysis through
fine-needle aspiration. However, these techniques exhibit limited sensitivity and
specificity in identifying malignant transformation. Emerging molecular diagnostics,
including analysis of carcinoembryonic antigen, glucose, IL1β, PGE2, and DNA sequencing
for mutations such as KRAS and GNAS, show promise in differentiating mucinous cysts
and identifying advanced dysplasia. Despite this, clinical integration remains limited.
Future efforts focus on noninvasive methods, including plasma-based liquid biopsies,
to complement cyst fluid analysis. A comprehensive biomarker panel integrating serum
and cyst fluid markers holds the potential to improve early detection, reduce overtreatment,
and optimize surgical management of high-risk PCN.
Keywords
IPMN - pancreas - pancreatic cystic neoplasms - intraductal papillary mucinous neoplasms
