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Colorectal cancer postoperative surveillance — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Colorectal cancer postoperative surveillanceUSMLE Step 3

A 63-year-old woman has an incidental 3.4-cm pancreatic-head cyst on MRI. It communicates with the main duct and contains an enhancing 7-mm mural nodule; the main pancreatic duct measures 7 mm. She has no pancreatitis or obstructive jaundice and is a surgical candidate. Which next diagnostic step is most appropriate?

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Correct answer: D — Perform endoscopic ultrasonography with targeted cyst and mural-nodule sampling

The best answer is “Perform endoscopic ultrasonography with targeted cyst and mural-nodule sampling”. Size above 3 cm, an enhancing mural nodule, and main-duct dilation are concerning features for advanced neoplasia in an IPMN. EUS provides high-resolution assessment of the nodule and permits targeted tissue and cyst-fluid sampling, which informs multidisciplinary surgical planning. Long-interval surveillance is reserved for lower-risk lesions, and neither PET nor enzyme testing substitutes for morphologic and cytologic risk assessment.

Reference: AGA: Pancreas Cysts—Best Approach: https://news.gastro.org/issues/2025/december/pancreas-cysts-what-s-the-best-approach/