SMAD4 and cyst: Recent studies focusing on cyst fluid nucleic acid markers have propelled this field into a new era.24 DNA/RNA-based next generation sequencing panels, designed based on PCN-related genomic variants such as KRAS, GNAS, TP53, SMAD4, RNF43, PIK3CA, VHL, and CTNNB1, have been validated and proven clinically available, demonstrating optimal diagnostic efficacy.13,14,25 Compared to nucleic acid markers, the exploration of cyst fluid protein biomarkers remains in a preliminary phase and necessitates further investigation.