Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Publication Date: April 1, 2015
Last Updated: September 2, 2022

Diagnosis

The AGA suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo MRI for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics. ( Very Low , Conditional (weak) )
612
The AGA suggests that pancreatic cysts with at least 2 high-risk features, such as size ≥3 cm, a dilated main pancreatic duct, or the presence of an associated solid component, should be examined with EUS-FNA. ( Very Low , Conditional (weak) )
612
The AGA suggests that patients without concerning EUS-FNA results should undergo MRI surveillance after 1 year and then every 2 years to ensure no change in risk of malignancy. ( Very Low , Conditional (weak) )
612
The AGA suggests that significant changes in the characteristics of the cyst, including the development of a solid component, increasing size of the pancreatic duct, and/or diameter ≥3 cm, are indications for EUS-FNA. ( Very Low , Conditional (weak) )
612

Management

The AGA suggests against continued surveillance of pancreatic cysts if there has been no significant change in the characteristics of the cyst after 5 years of surveillance or if the patient is no longer a surgical candidate. ( Very Low , Conditional (weak) )
612
The AGA suggests that patients with both a solid component and a dilated pancreatic duct and/or concerning features on EUS and FNA should undergo surgery to reduce the risk of mortality from carcinoma. (, )
612
The AGA recommends that if surgery is considered for a pancreatic cyst, patients are referred to a center with demonstrated expertise in pancreatic surgery. ( Very Low , Strong )
612
The AGA suggests that patients with invasive cancer or dysplasia in a cyst that has been surgically resected should undergo MRI surveillance of any remaining pancreas every 2 years. ( Very Low , Conditional (weak) )
612
The AGA suggests against routine surveillance of pancreatic cysts without high-grade dysplasia or malignancy at surgical resection. ( Very Low , Conditional (weak) )
612

Recommendation Grading

Overview

Title

Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Authoring Organization

Publication Month/Year

April 1, 2015

Last Updated Month/Year

April 2, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D010181 - Pancreatic Cyst, D010190 - Pancreatic Neoplasms

Keywords

pancreatic cyst, neoplastic cyst

Supplemental Methodology Resources

Technical Review