Genetic markers and confocal endomicroscopy as diagnostic approaches for pancreatic cystic lesion

Abstract

Background: Preoperative diagnosis of cystic lesions of the pancreas, which can be inflammatory or proliferative, continue to present clinicians with significant clinical challenges due to the heterogeneity of the pathological processes involved. Although malignant transformation in these lesions is unusual, the opportunity for curative surgery makes identification of suitable patients essential. This requires diagnostic approaches that are up to date and evidence based. Improved diagnostic accuracy will also ensure that unnecessary surgical procedures and the associated morbidity are avoided. Methods: In this abstract we present the Results of a review of recent diagnostic approaches for pancreatic cystic lesions (PCLs). Results: Genetic sequencing allows specific mutations to be identified including the genetic profiles associated with common PCLs. This provides a potential opportunity to determine changes that indicate the progression to malignant lesions. In this respect there is increasing interest in novel cyst fluid biomarkers and their potential to differentiate between mucinous and non-mucinous PCLs. A number of mutations have been found to be associated with the main types of PCLs and these are shown in Table 1. Confocal laser endomicroscopy (CLE) is another novel diagnostic technique which allows in vivo, real time microscopy during endoscopic procedures. CLE allows for the evaluation of histology with high resolution imaging and obviates the need for a biopsy. Conclusion: There is a need to identify diagnostic Methods or combinations of Methods that will allow us to more accurately identify PCLs at risk of malignant transformation or those where it has already occurred but patients may still benefit from potentially curative surgery. There is clearly a need for a comprehensive, standardised algorithm for the diagnosis and management of PCLs utilising all the currently available diagnostic modalities.