Yip-Schneider, Michele T.Muraru, RodicaKim, Rachel C.Wu, Howard H.Sherman, StuartGutta, AdityaAl-Haddad, Mohammad A.Dewitt, John M.Schmidt, C. Max2025-01-232025-01-232023Yip-Schneider MT, Muraru R, Kim RC, et al. EUS-guided fine needle aspiration-based clues to mistaken or uncertain identity: serous pancreatic cysts. HPB (Oxford). 2023;25(12):1587-1594. doi:10.1016/j.hpb.2023.09.009https://hdl.handle.net/1805/45406Background/objectives: Pancreatic serous cystic neoplasms (SCN) present a diagnostic challenge given their increasing frequency of detection and benign nature yet relatively high rate of misdiagnosis. Here, imaging and analyses associated with EUS-guided fine-needle aspiration (EUS-FNA) are evaluated for their ability to provide a correct preoperative diagnosis of SCN. Methods: A surgical cohort with confirmed pathological diagnosis of SCN (n = 62) and a surveillance cohort with likely SCN (n = 31) were assessed for imaging (CT/MRI/EUS) and EUS-FNA-based analyses (cytology/DNA analysis for Von Hippel-Lindau [VHL] gene alterations/biomarkers). Results: In the surgical cohort, CT/MRI and EUS respectively predicted SCN in 4 of 58(7%) and 19 of 62(31%). Cyst fluid cytology and VHL alterations predicted SCN in 1 of 51(2%) and 5 of 21(24%), respectively. High specificity cyst fluid biomarkers (vascular endothelial growth factor [VEGF]/glucose/carcinoembryonic antigen [CEA]/amylase) correctly identified SCN in 25 of 27(93%). In the surveillance cohort, cyst fluid biomarkers predicted SCN in 12 of 12(100%) while VHL alterations identified SCN 3 of 10(30%). Conclusion: High specificity cyst fluid biomarkers provided the most sensitive means of diagnosing SCN preoperatively. To obtain a preoperative diagnosis of SCN at the highest level of certainty, a multidisciplinary approach should be taken to inform appropriate SCN management.en-USPublisher PolicyCyst fluid biomarkersCytologyDNA analysisSerous cystic neoplasmArticle