Published online Jan 16, 2018. doi: 10.4253/wjge.v10.i1.1
Peer-review started: November 17, 2017
First decision: December 6, 2017
Revised: December 11, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 16, 2018
Processing time: 61 Days and 10.7 Hours
Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions (PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCLs. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.
Core tip: Current diagnostic guidelines for the evaluation of pancreatic cystic lesions have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. We propose that two new diagnostic technologies, confocal laser endomicroscopy and DNA-based molecular markers, may be used synergistically to improve diagnostic accuracy. In this review, we summarize the current literature regarding these two techniques.