Evaluating the prognostic efficacy of biomarkers in pancreatic cyst fluid

Orfeas P Varvarelis, Theodoros A Voulgaris, Androniki-Maria Skreka, Vasiliki Themelidi, Alexandra Voutsina, Antonios Vezakis
World J Gastrointest Endosc. 2025 Oct 16;17(10):109037. doi: 10.4253/wjge.v17.i10.109037.
Abstract
Evaluating the prognostic significance of biomarkers in pancreatic cyst fluid, accessed through endoscopic ultrasound-guided fine-needle aspiration, is essential for improving the clinical management of pancreatic cysts. This review synthesizes the evidence from studies published on the field in the last years, focusing on the accuracy and clinical utility of biomarkers such as carcinoembryonic antigen, intracystic glucose, and novel genetic markers including DNA mutation analysis. Our findings indicate that elevated carcinoembryonic antigen levels and decreased intra-cystic glucose levels are strongly associated with mucinous cysts which carry a higher malignancy risk, while DNA mutation analysis has shown increased predictive accuracy for identifying malignant transformations. Integrating these biomarkers with imaging techniques enhances risk stratification and can significantly influence therapeutic decisions. The review highlights the need for standardization of biomarker assays and further validation of biomarker panels to refine their prognostic value in clinical settings, ultimately aiding in the tailored management of patients with pancreatic cysts.