TABLE 3

Approach to surveillance of pancreatic cystic neoplasms based on the different society guidelines

Cyst sizeIAP6 (Kyoto), 2023ACG,7 2018AGA,9 2015ACR,8 2017European consensus,10 2018a
< 1 cmCT/MRI or EUS in 6 months and then every 18 months if stableMRI every 2 years for 4 yearsMRI in 1 year, then every 2 years for 5 years
Stop if no significant change in the characteristics of the cyst after 5 years of surveillance		MRI/CT every 1 year for cysts 1.5 cm to < 2 cm and every 6 months for cysts 2.0–2.5 cm for 4 times, then lengthen the interval
Stop after stability over 10 years		Surveillance every 6 months for 2 times with MRI with or without EUS or CA19-9
If stable, lifelong surveillance is recommended with annual MRI/EUS or CA19-9
1–2 cmMRI every 1 year for 3 years then every 2 years for 4 years
2–3 cmCT/MRI or EUS every 6 months for 2 times and then every 12 months if stableMRI/EUS every 6 months–1 year for 3 years then every year for 4 yearsFor cysts ≥ 2.5 cm, MRI/ CT every 6 months for 4 times, and if stable over initial 2 years, MRI/CT yearly for 2 times, then every 2 years for 3 times, then stop if stable over 10 years
For patients age ≥ 80, imaging every 2 years for 2 times, and stop if cyst is stable
> 3 cmCT/MRI or EUS every 6 monthsMRI/EUS every 6 months for 3 years then every year for 4 yearsPursue EUS-FNA

  • ↵a European consensus = European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy.

  • ACG = American College of Gastroenterology; ACR = American College of Radiology; AGA = American Gastroenterological Association; CA = carbohydrate antigen; CT = computed tomography; EUS = endoscopic ultrasonography; FNA = fine-needle aspiration; IAP = International Association of Pancreatology; MRI = magnetic resonance imaging