What are the current guidelines for the surveillance of patients with known pancreatic cysts, including frequency and type of imaging?

Surveillance of patients with known pancreatic cysts involves imaging primarily with pancreatic protocol CT scan or magnetic resonance cholangiopancreatography (MRI/MRCP).

Patients with pancreatic cysts should be offered either a pancreatic protocol CT scan or MRI/MRCP initially. If further information is needed after one of these tests, the other imaging modality should be offered.

Endoscopic ultrasound (EUS) is recommended after CT and MRI/MRCP if more information on the likelihood of malignancy is required or if it is unclear whether surgery is needed. Fine-needle aspiration during EUS may be considered to assess malignancy risk, with carcinoembryonic antigen (CEA) assay performed if sufficient sample is obtained.

Patients with high-risk features such as obstructive jaundice with cystic lesions in the pancreatic head, enhancing solid components in the cyst, or a main pancreatic duct diameter of 10 mm or larger should be referred for surgical resection.

The guidelines do not specify a fixed frequency for routine surveillance imaging of pancreatic cysts but emphasize the use of imaging modalities to assess changes or malignancy risk as clinically indicated.