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Cystic lesions of the pancreas (CLP) represent a relatively common pathologic entity affecting at least 1% of medical patients and represent a spectrum of lesions from inflammatory pseudocyststo malignant neoplasms. A significant percentage of these cysts are found incidentally during imaging work-up for unrelated conditions and require appropriate diagnostic testing to characterize the nature of the CLP. A multi-disciplinary approach to characterize CLP is currently used involving cytology, imaging, and cyst fluid analysis. The most recent international guidelines recommend resection of pancreatic mucinouscysts >3 cm, or smaller cysts with positive cytology, mural nodules, or symptoms.

Recent work utilized DNA analysis to characterize CLP as either mucinousor serous, and assess malignant potential. Focusing on k-rasgene point mutation, this group was able to detect mucinousdifferentiation (specificity 96%). Further, high amplitude k-rasmutations combined with allelic loss were 96% specific for malignancy. Correlation of k-rasmutation / allelic imbalances with CEA, however, showed poor agreement in the diagnosis of mucinousCLP.

Our aim is to determine the added benefit of molecular testing in diagnosing small (≤3 cm) pancreatic cysts.