Similarities and differences in guidelines for the management of pancreatic cysts

Table 4 Endoscopic ultrasound-fine needle aspiration indications

	Endoscopic ultrasound-Fine needle aspiration indications
European guidelines[28]	Differentiating mucinous vs non-mucinous
	Malignant vs benign
	CT or MRI unclear
	Only when results are expected to change clinical management
American College of Gastroenterology guidelines[30]	Jaundice
	Acute pancreatitis
	Significantly elevated serum CA 19-9
	Mural nodule
	A solid component within cyst or pancreatic parenchyma
	Dilation of MPD ≥ 5 mm
	Focal dilation of PD
	Cyst size > 3 cm
	When the diagnosis of cysts is unclear or results will likely alter management
	Cyst fluid CEA to differentiate IPMNs and MCNs from other cyst types
	New onset or worsening diabetes
	Increase in cyst size > 3 mm/yr
American Gastroenterology Association guidelines[31]	At least 2 high-risk features
	Cyst size ≥ 3 cm
	Dilated MPD
	Solid component
Revised IAP 2017 or revised Fukuoka guidelines[32]	Pancreatitis
	Cyst ≥ 3 cm
	Enhancing mural nodule < 5 mm
	Thickened/enhancing cyst wall
	Main duct size 5-9 mm
	An abrupt change in caliber of the pancreatic duct with distal pancreatic atrophy
	Lymphadenopathy
	Increased serum level of CA19-9
	Cyst growth rate ≥ 5 mm/2 yr
American College of Radiology guidelines[33]	Mural nodule
	Wall thickening
	Dilation of MPD ≥ 7 mm
	Extrahepatic biliary obstruction/Jaundice

EUS-FNA: Endoscopic ultrasound-Fine needle aspiration; MPD: Main pancreatic duct; PD: Pancreatic duct; MCN: Mucinous cystic neoplasm; CEA: Carcinoembryonic antigen; CT: Computed tomography; MRI: Magnetic resonance imaging; IAP: International association of pancreatology; IPMN: Intraductal papillary mucinous neoplasm.