title: Does EUS-FNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review.
abstract: BACKGROUND
  Endoscopic ultrasonography with fine needle aspiration (EUS-FNA) has become an integral tool in the diagnosis of pancreatic cystic lesions (PCLs) and the analysis of molecular/DNA abnormalities might improve the accuracy of pre-operative diagnosis. A review was conducted of all studies using EUS-FNA aspirates of PCLs to assess the accuracy and added benefit that molecular analysis provides to cytological analysis.
  
  
  METHODS
  A systematic review of the literature was conducted using PRISMA guidelines and electronic databases: PubMed/SCOPUS/EMBASE/Cochrane/CINAHL. Surgical pathology was used as the definitive reference standard. The QUADAS-2 tool was used for quality assessment.
  
  
  RESULTS
  In total, 162 articles were identified; 12 articles met inclusion/exclusion criteria. Ten studies reported on cytology and 8 studies reported k-ras mutational analysis. 362 patients (of 1115 total) had surgical pathology available. The sensitivity and specificity of cytology was 0.42 and 0.99; the sensitivity and specificity of k-ras was 0.39 and 0.95; and the sensitivity and specificity of the combined test of cytology and k-ras was 0.71 and 0.88, respectively.
  
  
  CONCLUSIONS
  k-ras mutational analysis used as an individual screening test has a poor diagnostic accuracy, as does cytology when used alone. The benefit comes with utilization in a combined fashion. More studies are needed to evaluate the correct sequence and utility of these tests for cyst differentiation.
authors.affiliation: Department of Surgery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Amy
authors.initials: A
authors.lastname: Gillis
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cipollone
authors.forename: Grainne
authors.initials: G
authors.lastname: Cousins
authors.forename: Kevin
authors.initials: K
authors.lastname: Conlon
mesh_terms: D004247:DNA / Q000032:analysis; D004252:DNA Mutational Analysis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D011905:Genes, ras / Q000235:genetics; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000235:genetics
chemical_list: D004247:DNA