Cytological detection of high grade this website dysplasia is the optimal detection point for providing early intervention, either surgically or with cyst ablation therapy (28),(33). Distinguishing intermediate grade dysplasia (e.g. moderate dysplasia (12) or borderline malignancy (34))

from high grade dysplasia (e.g. carcinoma in-situ (12)) is not only a challenge for histological analysis, but is especially a challenge for cytological analysis (35). The heterogeneity of the cyst lining typical of most mucinous cysts may cause the cells in the cyst fluid to under-estimate the final histological grade (27), and cellular degeneration coupled with a lack of standardized criteria and pathologist’s experience Inhibitors,research,lifescience,medical with these types of specimens contributes to the poor performance

Inhibitors,research,lifescience,medical of cytological analysis in many cases (personal experience). That being said, the recognition of high-grade dysplasia on cytological analysis is a powerful finding for early detection of cancer (28),(33), and if you don’t look, you won’t find it. Aside from CEA, amylase and cytological analysis, the future is looking to pancreatic cyst fluids as a rich source of DNA for molecular analysis. There is an explosion of research in this area which is beyond the scope of this editorial. In brief and to the best of our knowledge, no established molecular test is specific for the detection of malignancy. A KRAS mutation Inhibitors,research,lifescience,medical supports a mucinous etiology, but is inaccurate in distinguishing IPMN from MCN or in determining malignancy (36),(37). The very recent report of GNAS mutation analysis shows promise in distinguishing mucinous from serous cysts and IPMN from MCN, but, again, is not a mutation that correlates with histological grade (38). While further development of more specific markers of cyst type and biological behavior Inhibitors,research,lifescience,medical is awaited, imaging and cyst fluid analysis, including CEA, amylase and cytology, currently offer the best means of accurately assessing pancreatic cysts preoperatively. If cyst fluid analysis does Inhibitors,research,lifescience,medical not support a mucinous etiology on the one hand, or high grade dysplasia in a mucinous cyst on the other, conservative patient management is a viable alternative in asymptomatic

patients without high risk imaging features, especially in an unsuitable surgical candidate. during Footnotes No potential conflict interest.
Within the last year more than 42,000 people in the United States were newly diagnosed with pancreatic cancer, which makes it the fourth leading cause of cancer mortality (1). A majority of patients diagnosed with pancreatic cancer are considered inoperable at the time of the diagnosis due to locally advanced disease or the presence of metastasis, and the efficacy of systemic chemotherapy is limited (2). The prognosis for these patients is one of the worst among all cancers: according to EUROCARE study, based on over 30,000 cases, overall survival at 1,3 and 5 years was 16%, 5% and 4%, respectively (3).