Pancreatic cystic lesions (PCL) comprise a wide spectrum of pathological
entities, from benign lesions such as retention cysts and pseudocysts to potentially
malignant ones such as mucinous cystic neoplasms and intraductal papillary mucinous
neoplasms. Due to the widespread use of cross-sectional imaging for various
indications, PCLs are being increasingly identified in clinical practice and they can
pose diagnostic challenges sometimes. Among the broad differential diagnosis of a
PCL, the stake is to accurately detect lesions with a malignant potential. Along with the
medical history of the patient and the imaging features of the PCL, endoscopic
ultrasound (EUS) plays an important role in the management of these lesions, by
providing detailed morphologic assessment including vascular pattern and detection of
solid component, cyst fluid analysis and tissue diagnosis. We herein summarize the
currently available evidence with regard to diagnostic updates in PCLs, focusing on
recent advances in tissue acquisition and diagnosis – the micro-biopsy forceps,
confocal laser endomicroscopy and cyst fluid markers. Although in an early phase,
artificial intelligence applications in PCLs are briefly discussed. In summary, there has
been significant progress in PCL diagnosis over the last few years and there is growing
evidence that accuracy will be further improved by routine use of molecular markers in
cyst fluid.
Keywords: Confocal laser endomicroscopy, Cyst fluid, Endoscopic ultrasound, Mucinous, Micro-biopsy forceps, Neoplastic, Pancreatic cyst.
