Varvarelis OP, Voulgaris TA, Skreka AM, Themelidi V, Voutsina A, Vezakis A. Evaluating the prognostic efficacy of biomarkers in pancreatic cyst fluid. World J Gastrointest Endosc 2025; 17(10): 109037 [DOI: 10.4253/wjge.v17.i10.109037]
Corresponding Author of This Article
Antonios Vezakis, Department of Endoscopy, 2ND Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vasilissis Sofias 76, Athens 11528, Greece. avezakis@hotmail.com
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Gastroenterology & Hepatology
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 16, 2025 (publication date) through Oct 19, 2025
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Varvarelis OP, Voulgaris TA, Skreka AM, Themelidi V, Voutsina A, Vezakis A. Evaluating the prognostic efficacy of biomarkers in pancreatic cyst fluid. World J Gastrointest Endosc 2025; 17(10): 109037 [DOI: 10.4253/wjge.v17.i10.109037]
World J Gastrointest Endosc. Oct 16, 2025; 17(10): 109037 Published online Oct 16, 2025. doi: 10.4253/wjge.v17.i10.109037
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
Orfeas P Varvarelis, Theodoros A Voulgaris, Androniki-Maria Skreka, Vasiliki Themelidi, Antonios Vezakis, Department of Endoscopy, 2ND Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
Alexandra Voutsina, Institute of Chemical Biology, National Hellenic Research Foundation, Athens 11528, Greece
Co-first authors: Orfeas P Varvarelis and Theodoros A Voulgaris.
Author contributions: Varvarelis OP, Voulgaris TA, Skreka AM, and Themelidi V wrote the initial draft; Varvarelis OP and Voulgaris TA contributed equally to this article, they are the co-first authors of this manuscript; Voutsina A and Vezakis A reviewed and finalised the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonios Vezakis, Department of Endoscopy, 2ND Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vasilissis Sofias 76, Athens 11528, Greece. avezakis@hotmail.com
Received: April 29, 2025 Revised: June 3, 2025 Accepted: September 11, 2025 Published online: October 16, 2025 Processing time: 171 Days and 9.4 Hours
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.
Core Tip: The analysis of pancreatic cyst fluid obtained via endoscopic ultrasound-guided fine-needle aspiration provides critical diagnostic and prognostic information. Conventional biomarkers, such as carcinoembryonic antigen and intra-cystic glucose, which can be offered as a point-of-care assay, remain valuable tools for distinguishing mucinous from non-mucinous cysts. However, neither reliably differentiates malignant from benign mucinous cysts. While emerging genetic markers represent a promising advancement, fine-needle biopsy remains the most reliable method for accurately characterizing cysts with malignant potential Continued progresses in molecular diagnostics and integrated clinical models are essential to optimize the management of pancreatic cystic lesions.
