Management of Incidental Pancreatic Cysts
Features
Size
1
<1.5 cm
1.5-1.9 cm
2.0-2.5 cm
>2.5 cm
Age
<65 years old
65-79 years old
>80 years old
Main pancreatic Duct Communication
Present
Absence
Indeterminant
Risk by Imaging?
low risk
high risk
serous cystademoma
Recommendations
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1. For cystic lesions < 5 mm: a single follow-up MRI or CT at 2 years demonstrating stability may be sufficient to stop surveillance for patients <75 years old. For patients 75 years of age and over, radiologists may choose to not report cystic lesions <5 mm in size.
2. MRI is generally recommended for follow up imaging. Pancreatic protocol CT abdomen may be obtained in patients who are not candidates for MRI.
3. Recommendations derived from: Megibow AJ, et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017;14:911-923. (Available at: https://www.jacr.org/article/S1546-1440(17)30318-6/fulltext) The recommendations above represent only the initial step in diagnostic evaluation upon first discovering an incidental pancreatic cystic lesion. Refer to the reference above for full details on implementation of the recommendations, especially in the event of interval cyst growth on follow up. Refer directly to the reference above for recommendations following these initial steps as well.