# A combination of molecular markers and clinical features improve the classification of pancreatic cysts

Source: https://onco.cc/key-papers/paper-springer-pancreatic-cyst-molecular-classification-gastroenterology-2015/  
OnCo record `paper-springer-pancreatic-cyst-molecular-classification-gastroenterology-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Testing cyst fluid for a panel of gene mutations alongside the clinical picture classified 130 removed pancreatic cysts almost perfectly and would have avoided nine in ten of the operations that turned out to be unnecessary.

## Summary

Multicentre retrospective study of 130 patients with resected pancreatic cystic neoplasms (12 serous cystadenomas, 10 solid pseudopapillary neoplasms, 12 mucinous cystic neoplasms, 96 IPMNs). Cyst fluid was analysed for mutations in BRAF, CDKN2A, CTNNB1, GNAS, KRAS, NRAS, PIK3CA, RNF43, SMAD4, TP53 and VHL, loss of heterozygosity at CDKN2A, RNF43, SMAD4, TP53 and VHL, and aneuploidy. Molecular markers with clinical features classified cyst type with 90 to 100% sensitivity and 92 to 98% specificity; the marker panel correctly identified 67 of the 74 patients who did not need surgery, a potential 91% reduction in unnecessary operations.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Gastroenterology
- Year: 2015
- DOI: 10.1053/j.gastro.2015.07.041
- Authors: Springer S, Wang Y, Dal Molin M, et al.
- Findings: Cyst type classified with 90 to 100% sensitivity and 92 to 98% specificity.; Would have avoided 91% of the unnecessary operations in the cohort.
- What it means: The evidence that molecular cyst-fluid testing can spare operations, now part of specialist practice although not a universal standard.
- Caveats: Retrospective on resected cysts, so selection is towards operated lesions.; Prospective validation of the composite classifier is limited.

## Sources

- Springer et al., Gastroenterology 2015: molecular markers plus clinical features classify 130 resected cysts: https://doi.org/10.1053/j.gastro.2015.07.041
- PubMed: https://pubmed.ncbi.nlm.nih.gov/26253305/

## Connected records

- cancers: [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- targets: [CDKN2A](https://onco.cc/targets/cdkn2a/), [CTNNB1](https://onco.cc/targets/ctnnb1/), [GNAS](https://onco.cc/targets/gnas/), [KRAS](https://onco.cc/targets/kras/), [RNF43](https://onco.cc/targets/rnf43/), [SMAD4](https://onco.cc/targets/smad4/), [TP53](https://onco.cc/targets/tp53/)
- institutions: [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/)
- terms: [Biopsy](https://onco.cc/terms/biopsy/)
- people: [Bert Vogelstein](https://onco.cc/people/bert-vogelstein/), [Luis A. Diaz Jr.](https://onco.cc/people/luis-diaz/)
- journals: [Gastroenterology](https://onco.cc/journals/gastroenterology/)

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