{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T23:17:05Z","timestamp":1768000625314,"version":"3.49.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pancreas"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>To evaluate the diagnostic accuracy of <jats:italic toggle=\"yes\">KRAS<\/jats:italic> mutation in pancreatic cystic fluid and compare it with carcinoembryonic antigen and cytology, we identified studies with cyst fluid obtained by endoscopic ultrasound prior to surgery. We classified cysts as malignant, premalignant, and benign. A random-effects model was used for quantitative meta-analysis. Pooled sensitivities, specificities, and summary receiver operating characteristic curve analysis were conducted. We analyzed 16 studies, with 3429 patients, including 731 referred for surgery. Carcinoembryonic antigen was better for clinically significant cysts (premalignant and malignant) with sensitivity = 0.58 (95% confidence interval [CI], 0.53\u20130.65), specificity = 0.9 (95% CI, 0.76\u20130.97), and area under the curve (AUC) = 0.69. Cytology performed better in malignant cysts, with sensitivity = 0.37 (95% CI, 0.27\u20130.48), specificity = 0.96 (95% CI, 0.93\u20130.98), and AUC = 0.78. Isolated, <jats:italic toggle=\"yes\">KRAS<\/jats:italic> mutation failed the diagnosis of malignant and significant cysts, with sensitivities = 0.43 (95% CI, 0.34\u20130.43) and 0.46 (95% CI, 0.42\u20130.51), specificities = 0.62 (95% CI, 0.56\u20130.68) and 0.97 (95% CI, 0.92\u20130.99), and AUCs = 0.56 and 0.53, respectively. Carcinoembryonic antigen and cytology are more accurate than <jats:italic toggle=\"yes\">KRAS<\/jats:italic>. Additional studies are lacking to recommend <jats:italic toggle=\"yes\">KRAS<\/jats:italic> as a single diagnostic test.<\/jats:p>","DOI":"10.1097\/mpa.0000000000001325","type":"journal-article","created":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T11:10:44Z","timestamp":1560769844000},"page":"749-758","source":"Crossref","is-referenced-by-count":12,"title":["KRAS in Cyst Fluid Obtained by Endoscopic Ultrasound\u2013Fine-Needle Aspiration in Pancreatic Cystic Lesions"],"prefix":"10.1097","volume":"48","author":[{"given":"Sandra","family":"Faias","sequence":"first","affiliation":[]},{"given":"Luisa","family":"Pereira","sequence":"additional","affiliation":[]},{"given":"\u00c2ngelo","family":"Lu\u00eds","sequence":"additional","affiliation":[]},{"given":"Mar\u00edlia","family":"Cravo","sequence":"additional","affiliation":[]},{"given":"Ant\u00f3nio","family":"Dias Pereira","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Instituto Portugu\u00eas de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa;"}]},{"given":"Joana","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hospital Beatriz \u00c2ngelo, Loures; and"}]}],"member":"276","reference":[{"key":"bib1-20231116","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1001\/jama.2016.4690","article-title":"Pancreatic cyst disease: a review","volume":"315","year":"2016","journal-title":"JAMA"},{"key":"bib2-20231116","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1097\/MPA.0b013e31821bd62f","article-title":"Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts","volume":"40","year":"2011","journal-title":"Pancreas"},{"key":"bib3-20231116","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1159\/000243733","article-title":"Incidental pancreatic cysts: do we really know what we are watching?","volume":"10","year":"2010","journal-title":"Pancreatology"},{"key":"bib4-20231116","doi-asserted-by":"crossref","first-page":"3112","DOI":"10.1245\/s10434-013-2986-6","article-title":"Pre-operative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy","volume":"20","year":"2013","journal-title":"Ann Surg Oncol"},{"key":"bib5-20231116","doi-asserted-by":"crossref","first-page":"E391","DOI":"10.1055\/s-0042-101755","article-title":"The value of KRAS mutation testing with CEA for the diagnosis of pancreatic mucinous cysts","volume":"4","year":"2016","journal-title":"Endosc Int Open"},{"key":"bib6-20231116","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1053\/j.gastro.2015.07.041","article-title":"A combination of molecular markers and clinical features improve the classification of pancreatic cysts","volume":"149","year":"2015","journal-title":"Gastroenterology"},{"key":"bib7-20231116","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1136\/gutjnl-2016-313586","article-title":"Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia","volume":"67","year":"2018","journal-title":"Gut"},{"key":"bib8-20231116","first-page":"92ra66","article-title":"Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development","volume":"3","year":"2011","journal-title":"Sci Transl Med"},{"key":"bib9-20231116","doi-asserted-by":"crossref","first-page":"4381","DOI":"10.1158\/1078-0432.CCR-14-0513","article-title":"Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts","volume":"20","year":"2014","journal-title":"Clin Cancer Res"},{"key":"bib10-20231116","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1136\/gutjnl-2018-316027","article-title":"European Study Group on Cystic Tumours of the Pancreas. 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