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.