Screening for pancreatic cancer: what can cyst fluid analysis tell us?

Pancreatic cysts are increasingly recognized as a dilemma in clinical practice because of their uncertain risk of malignancy. Because diagnosis by cytology is insensitive, current guidelines suggest using radiographic and clinical criteria to determine the appropriateness of surgery or surveillance, although this is far from perfect. Several cyst fluid biomarkers have been reported to aid diagnosis, and to date, carcinoembryonic antigen is the most accurate in detecting potentially cancerous mucinous cysts, but not in detecting malignant cysts. Recent studies have highlighted novel cyst fluid biomarkers based on DNA analysis, protein expression profiling, and secreted proteins that, if validated, may improve diagnosis and management.