When should I consider referring a patient with a pancreatic cyst to a specialist for further evaluation?

Consider referring a patient with a pancreatic cyst to a specialist for further evaluation if any of the following high-risk features are present:

• Obstructive jaundice with cystic lesions in the head of the pancreas.
• Enhancing solid component within the cyst.
• Main pancreatic duct diameter of 10 mm or larger.

Additionally, offer a pancreatic protocol CT scan or MRI/MRCP initially, and if further information is needed, consider the other imaging modality or endoscopic ultrasound (EUS) with EUS-guided tissue sampling.

Referral is also indicated if malignancy is suspected based on imaging or cytology results.