Original Contribution | Published:


Incidental Cystic Neoplasms of Pancreas: What Is the Optimal Interval of Imaging Surveillance?

The American Journal of Gastroenterology volume 103, pages 16571662 (2008) | Download Citation

This study was presented as an oral presentation at the 2006 American College of Gastroenterology Annual meeting in Las Vegas, NV.




The optimal interval of imaging studies for surveillance of incidental pancreatic cystic neoplasms is not known.


A retrospective analysis of longitudinal medical records of patients with pancreatic cystic neoplasms was performed to examine the natural history of incidentally detected cystic pancreatic neoplasms with respect to the development of significant growth and to identify predictors of such growth.


After excluding patients with small (<10 mm) cysts (N = 144) and inadequate clinical follow-up of less than 6 months (N = 79) and those with a clinical diagnosis of pancreatic pseudocysts, serous cystadenoma, main duct intraductal papillary mucinous neoplasm (N = 29), and neuroendocrine tumor (N = 3), in total, 166 cysts in 150 patients were available for analysis. The working diagnoses on these cysts (based on clinical, radiological features, aspiration cytology, cyst fluid analysis, and surgical pathology data when available) were mucinous cystic neoplasm in 117 and branch-type intraductal papillary mucinous neoplasm in 49. The mean standard error (SE) initial size of these cysts was 2 (0.1) cm. Over a median period of follow-up of 32 (IQR [inter-quartile range] 19–48) months, 89% of all the cysts did not show significant growth during the follow-up. In a multivariate Cox proportional hazards model, the initial size of the cystic lesion was an independent predictor of significant growth during follow-up (relative risk 1.28, 95% confidence interval [CI] 1.08–1.61, P= 0.01); the only other significant variable was the presence of intracystic or mural nodule (relative risk 38.6, 95% CI 2.3–654, P= 0.01).


Most incidentally detected cystic neoplasms of the pancreas did not have significant growth during follow-up. Such growth is unlikely to occur before 2 yr of the baseline evaluation, and we suggest that the optimal imaging interval during follow-up of these patients should be at 2 yr from the baseline evaluation, particularly in cystic lesions 3.0 cm or less in size and without intracystic or mural nodules.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    , , , et al. Analysis of small cystic lesions of the pancreas. Int J Pancreatol 1995;18:197–206.

  2. 2.

    , , , et al. Cystic pancreatic neoplasms: Observe or operate. Ann Surg 2004;239:651–659.

  3. 3.

    . Approach to cystic pancreatic lesions. Gastrointest Endosc Clin N Am 2005;15:485–496.

  4. 4.

    , , . Presentation and management of pancreatic cystic neoplasms. J Clin Gastroenterol 2007;41:599–608.

  5. 5.

    , , , et al. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 2003;90:1244–1249.

  6. 6.

    , , , et al. Branch-duct intraductal papillary mucinous neoplasms: Observations in 145 patients who underwent resection. Gastroenterology 2007;133:72–79.

  7. 7.

    , , , et al. International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17–32.

  8. 8.

    , , , et al. Nonsurgical management of asymptomatic incidental pancreatic cysts. Clin Gastroenterol Hepatol 2007;5:813–817.

  9. 9.

    , , , et al. Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: Long-term follow-up results. Gut 2008;57:339–343.

  10. 10.

    , , , et al. The natural history of the incidentally discovered small simple pancreatic cyst: Long-term follow-up and clinical implications. AJR Am J Roentgenol 2005;184:20–23.

  11. 11.

    , , , et al. Natural history of indeterminate pancreatic cysts. Surgery 2005;138:665–670.

  12. 12.

    , , , et al. Pancreatic cysts 3 cm or smaller: How aggressive should treatment be? Radiology 2006;238:912–919.

  13. 13.

    , , , et al. A selective approach to the resection of cystic lesions of the pancreas: Results from 539 consecutive patients. Ann Surg 2006;244:572–582.

  14. 14.

    International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM). : Practice Management Information Corporation: Los Angeles, 2001.

  15. 15.

    , , . Statistical methodology: IX. Survival analysis. Acad Emerg Med 1999;6:244–249.

  16. 16.

    , , , et al. Risk of malignancy in resected cystic tumors of the pancreas = 3 cm in size: Is it safe to observe asymptomatic patients? A Multi-institutional report. J Gastrointest Surg 2008;12:234–242.

  17. 17.

    , , , et al. How useful are clinical, biochemical, and cross-sectional imaging features in predicting potentially malignant or malignant cystic lesions of the pancreas? Results from a single institution experience with 220 surgically treated patients. J Am Coll Surg 2008;206:17–27.

  18. 18.

    , . Evaluation and management of cystic pancreatic tumors: Emphasis on the role of EUS FNA. Clin Gastroenterol Hepatol 2004;2:639–653.

  19. 19.

    , , , et al. ASGE guideline: The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas. Gastrointest Endosc 2005;61:363–370.

  20. 20.

    , , , et al. Diagnosis of pancreatic cystic neoplasms: A report of the cooperative pancreatic cyst study. Gastroenterology 2004;126:1330–1336.

  21. 21.

    , , , et al. Clinico-pathological features of cystic pancreatic endocrine neoplasms and a comparison with their solid counterparts. Eur J Surg Oncol 2006;32:553–556.

  22. 22.

    , , , et al. Cystic neoplasms of the pancreas. N Engl J Med 2004;351:1218–1226.

  23. 23.

    , , . Optimal management of pancreatic cysts—a cost-effectiveness analysis. Gastrointest Endosc 2006;63:AB273.

  24. 24.

    , , , et al. Preoperative evaluation of pancreatic cystic lesions: Cost-benefit analysis and proposed management algorithm. Surgery 2005;138:672–679.

Download references

Author information


  1. Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona

    • Ananya Das
    • , Christopher D Wells
    •  & Cuong C Nguyen


  1. Search for Ananya Das in:

  2. Search for Christopher D Wells in:

  3. Search for Cuong C Nguyen in:

Corresponding author

Correspondence to Ananya Das.

About this article

Publication history






Further reading