Table III.

Proposed Ancillary Tests for Solid Pancreatic Lesions

Marker	Purpose	Diagnostic finding	Utility
KRAS mutations	Identification of adenocarcinoma	Mutation present	Insufficient specificity for malignancy to warrant usage
SMAD4	Identification of adenocarcinoma	Mutation present [IHC shows loss of staining]	Supports the diagnosis of adenocarcinoma
FISH	Identification of adenocarcinoma	Presence of copy number abnormalities in CEP3, CEP7, CEP17 and abnormalities of band 9p21 favor malignancy	Most reliable test for confirming adenocarcinoma in conjunction with routine cytology
Mesothelin	Identification of malignancy	Overexpression of mesothelin by IHC	Supports the diagnosis of adenocarcinoma
Loss of heterozygosity	Identification of adenocarcinoma	Losses of chromosome arms 3p, 6Qp and 10pq along with gains of 5q, 12q, 18q, and 20q supports a diagnosis adenocarcinoma	Clinical importance to be determined
microRNAs	Identification of adenocarcinoma	Presence of miRNA including miR-21 and mi-155 supports a diagnosis of adenocarcinoma	Clinical utility to be determined