Copyright ©The Author(s) 2016.
World J Gastroenterol. Jan 21, 2016; 22(3): 1236-1245
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1236
Table 1 Key differences between 2012 International Association of Pancreatology and 2015 American Gastroenterological Association guidelines for the management of pancreatic cysts[10,20]
Specifics of guidelines2012 IAP2015 AGA
Patient population targeted by guidelineSuspected MCN and IPMNAll incidental pancreatic cysts
Recommended imaging modalityPancreatic protocol CT or MRIMRI pancreas with MRCP
Threshold for recommending EUS and/or surgery1 risk factorAt least 2 risk factors
Surveillance recommendations in unresected cystsFrequent surveillance based on cyst sizeMRI in 1 yr and then every 2 yr
Stopping surveillanceNo explicit recommendation to stop in unresected cysts Following resection of serous cystadenoma and MCN without invasive cancerAfter 5 yr of stable unresected cyst without development of high risk features Surgically unfit patients Select resected cysts including BD-IPMN with no, low or moderate-grade dysplasia
Table 2 Recommended cyst fluid studies[28,33,34,40]
Cyst fluid testTest characteristicsDiagnosis
String sign ≥ 1 cm, ≥ 1 s95% specificity, 94% positive predictive valueMucinous
Cyst fluid cytology63% sensitivityMucinous or malignant
Cyst wall cytology29% increased diagnostic yieldMucinous or malignant
CEA > 192 ng/mL75% sensitivity, 84% specificityMucinous
CEA < 5 ng/mL50% sensitivity, 95% specificitySerous cystadenoma, pseudocyst, cystic neuroendocrine tumor
Amylase < 250 U/L44% sensitivity, 98% specificityExcludes pseudocyst
Table 3 Recommended surveillance modalities and intervals for unresected pancreatic cysts according to 2012 International Association of Pancreatology guideline[10]
< 1 cmCT/MRI2-3 yr
1-2 cmCT/MRI1 yr (lengthen if no change after 2 yr)
2-3 cmEUS, MRIEUS in 3-6 mo, then lengthen interval thereafter alternating MRI and EUS
> 3 cmEUS, MRIAlternate MRI and EUS every 3-6 mo