Advanced diagnostics for pancreatic cysts: Confocal endomicroscopy and molecular analysis

Table 4 Benefits and drawbacks of molecular analysis of cyst fluid and confocal endomicroscopy[11,12,15,29,34]

Molecular analysis of PCL fluid	EUS-nCLE of PCLs
(DNA analysis)
High sensitivity and specificity for the diagnosis of mucinous PCLs	High sensitivity and specificity for the diagnosis of mucinous PCLs
Markers can detect advanced neoplasia in IPMNs; need validation in multicenter studies	Need further studies to address role of EUS-nCLE in the identification of advanced neoplasia in PCLs
Lower sensitivity for the detection of KRAS mutations in MCNs	Detection of flat epithelium in MCNs can be difficult for early adapters of EUS-nCLE
Need large multicenter prospective studies with confirmed histopathology to replicate single center results	Need large multicenter prospective studies with confirmed histopathology to replicate single center results
Lack of established markers for cystic-NET and squamous lined cysts	EUS-nCLE reveals specific image patterns for different PCL types. Unable to differentiate between cystic-NET and SPN
During EUS-FNA, 5%-10% of PCLs may not yield DNA for molecular analysis	There is a 2%-5% risk of technical and procedural issues with failure of image acquisition during EUS-nCLE
Low sensitivity for the detection of VHL mutations in SCAs	EUS-nCLE identifies characteristic ‘fern-pattern’ of vascularity for diagnosing SCAs

PCL: Pancreatic cystic lesions; MCN: Mucinous cystic neoplasm; EUS: Endoscopic ultrasound; nCLE: Needle based confocal laser endomicroscopy; FNA: Fine needle aspiration; Cystic-NET: Cystic neuroendocrine tumor; SPN: Solid pseudopapillary neoplasm.