Our study cohort included 23 isolated HG-PanINs from 21 patients; samples were retrieved from the database of the Department of Pathology of The Johns Hopkins Hospital or collected from the participating institutions after the approval of the Institutional Review Board. Neoplastic cells were isolated from formalin-fixed, paraffin-embedded (FFPE) tissue sections by laser capture microdissection (supplementary material, Figure S1). DNA was extracted and analysed by targeted next-generation sequencing of pancreatic cancer driver genes using Ion AmpliSeq library preparation on an IonTorrent Personal Genome Machine (17 HG-PanINs and 16 LG-PanINs) or by whole-exome sequencing using Agilent SureSelect library preparation on an Illumina HiSeq (five HG-PanINs). In addition, immunohistochemistry for p53 and SMAD4 protein was performed on FFPE sections (18 HG-PanINs). Additional details are provided in the Supplementary materials and methods.