The utility of molecular studies on pancreatic cystic lesions: A comprehensive review

•Pancreatic cystic lesions (PCLs) pose diagnostic challenges.•Next-generation sequencing (NGS) enhances diagnostic accuracy of PCLs.•PancreaSeq and PancraGEN effectively analyze genetic alteration in PCLs.•Molecular diagnostics enable personalized treatment strategies. Pancreatic cystic lesions, frequently detected in abdominal imaging, pose diagnostic challenges due to their varying malignancy potential. This review article focuses on the crucial role of molecular diagnostics in differentiating these lesions, with an emphasis on the significance of KRAS and GNAS mutations identified through endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The use of next-generation sequencing (NGS) is highlighted for its precision in detecting genetic changes, crucial for accurate diagnosis and guiding management decisions. Integration of molecular studies into standardized reporting for pancreaticobiliary cytopathology is also discussed, enhancing diagnostic accuracy. The potential of precision oncology, informed by molecular insights, is explored for targeted treatments of pancreatic cystic lesions. Commercial platforms like PancreaSeq® Genomic Classifier and PancraGEN® are assessed for their effectiveness in analyzing pancreatic cystic fluid, proving beneficial in cases where traditional methods fall short. In summary, molecular studies are indispensable in evaluating pancreatic cystic lesions, offering a pathway to more personalized treatment and management strategies in patient-centered care.