Endoscopic Ultrasound fine-needle aspiration and cystic fluid analysis in patients with pancreatic cystic lesions.

Pancreatic cystic lesions have been increasingly detected with the widespread use of cross-sectional imaging. As these lesions are heterogeneous, differentiating benign from (potentially) malignant cystic lesions is important as well as challenging. Endoscopic ultrasound assessment, combined with cyst fluid analysis, forms the cornerstone of the diagnostic algorithm. Biochemical markers such as carcinoembryonic antigen (CEA), amylase, and glucose have been shown to distinguish mucinous from non-mucinous cystic lesions. Each parameter has its own advantages and its own limitations. Novel molecular markers, such as DNA-based assays and next-generation sequencing, have shown promise. The various guidelines have incorporated cyst fluid analysis in their recommendations. A standardized multimodal approach is essential, incorporating all aspects. This review synthesizes evidence on the utility of endoscopic ultrasound (EUS)-guided cyst fluid analysis in the management of pancreatic cystic lesions.