The evaluation of pancreatic cysts requires a multidisciplinary approach. No single diagnostic test provides 100% sensitivity and specificity. The absence of cyst lining cells implies a pseudocyst in the appropriate clinical setting, but this is a diagnosis of exclusion. In the case of cysts the fluid is separately submitted for carcinoembryonic antigen (CEA), amylase, CA125 and CA19.9 testing.
Pitfalls of pancreatic cyst fluid cytology
- Failure to sample epithelium (non-diagnostic sample)
- Difficulty in categorizing epithelium as serous or mucinous
- Failure to sample dysplastic/malignant epithelium
- Contamination by gastrointestinal tract epithelium or mucin
- Sampling of a non-pancreatic cyst