Table Info

Table 1.

Guidelines for the management and risk stratification of pancreatic cystic lesions

Association/Society	Scope	Risk stratification/Indications for resection
IAP, 2024 (Kyoto) [9]	IPMNs	High risk stigmata MPD dilation ≥ 10 mm Enhancing mural nodule ≥ 5 mm or solid component Obstructive jaundice Cytology positive or suspicious Worrisome features Cyst ≥ 3 cm MPD dilation > 5 mm and < 10 mm Enhancing mural nodule < 5 mm New onset or worsening diabetes Thickened/Enhancing cyst walls Lymphadenopathy Abrupt changed in duct caliber with distal atrophy Growth rate ≥ 5 mm/year Acute pancreatitis Elevated CA19-9
ACR, 2017 [11]	Incidentally detected cysts	High risk stigmata Enhancing solid component MPD > 10 mm absence of obstruction HGD cytology Worrisome features Cyst > 3 cm Enhancing cyst wall Non-enhancing mural nodule MPD > 7 mm
ACG, 2018 [12]	Newly diagnosed lesions w/o family history or genetic predispositions	Concerning features Cyst growth > 3 mm/year Mural nodule MPD dilation > 5 mm IPMN/MCN > 3 cm
AGA, 2015 [7]	Asymptomatic non-neoplastic PCL	Concerning features Cyst > 3 cm Dilated MPD Solid component HGD cytology
European, 2018 [13]	All PCL MCN resection if > 4 cm (all other regardless of size)	Absolute indication HGD cytology Solid mass Enhancing mural nodule > 5 mm MPD dilation > 10 mm Relative indications Growth rate > 5 mm/year CA19-9 > 37 U/mL Enhancing mural nodule < 5 mm Cyst diameter > 4 cm MPD dilation 5–9.9 mm

IAP: International Association of Pancreatology; IPMNs: intraductal papillary mucinous neoplasms; MPD: main pancreatic duct; ACR: American College of Radiology; HGD: high-grade dysplasia; MCN: mucinous cystic neoplasm; ACG: American College of Gastroenterology; AGA: American Gastrointestinal Association; PCL: pancreatic cystic lesions

Declarations

Author contributions

REA: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. NB and NVT: Investigation, Writing—original draft, Writing—review & editing. AT and ND: Investigation, Writing—original draft. SA: Conceptualization, Investigation, Writing—review & editing, Supervision.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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All the images in the article were collected anonymously and there are no identifiable personal data, following Chart #245 CFR 46.104(d), therefore the Human Research Protection Office at UPMC exempted the ethical approval of this manuscript.

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Human Research Protection Office at UPMC exempted informed consent to participate in this manuscript.

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Availability of data and materials

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