SMAD4 and Pancreatic cysts: In the previously described study published by Springer et al., the resultant composite of SMAD4, RNF43, chromosomal aneuploidy, and TP53 were subsequently combined with the MOCA-identified composite of clinical features with an ultimate sensitivity and specificity of 75% and 92%, respectively, in identifying pancreatic cysts requiring surgery, outperforming the sensitivity of the Fukuoka guidelines but at the cost of specificity [58].