Pancreatic Cyst Surveillance Protocol

Patients with pancreatic cysts are divided into high-risk and low-risk categories based on certain criteria, such as:

  • Size of the cyst
  • Family history of pancreatic cancer
  • Symptoms related to the pancreas, such as an episode of pancreatitis
  • Worrisome features of the cysts on CT scan or MRI (see below)
  • Analysis of the cyst fluid, which can be sampled by an advanced endoscopic procedure

Low-risk category

  • No history of pancreatitis or symptoms related to the pancreas, such as:
    • Fatty, oily stools
    • Yellowing of the eyes or skin
    • Diabetes
    • Weight loss
  • No worrisome findings on imaging (see below)
  • No history of significant tobacco use
  • No obesity
  • Cyst size < 3 cm
  • No significant family history of pancreatic cancer or pancreatic cysts
  • No worrisome findings on analysis of pancreatic cyst fluid

Worrisome features noted on imaging include

  • Cyst size > 3 cm
  • Thickened cyst walls
  • Dilation of the main pancreatic duct to 5-9 mm
  • Rapid and/or significant increase in the size of the cyst
  • An associated mass or nodule in the cyst
  • Change in the diameter of the main pancreatic duct
  • A cyst or mass causing blockage of the bile duct
  • Concern for cystic involvement of the main pancreatic duct rather than the side branches of the pancreatic duct
  • Changes in the appearance of the pancreas adjacent to the cyst

Surveillance of pancreatic cysts

  • All patients should undergo evaluation and surveillance, which includes multidisciplinary review of their individual case.
  • The frequency and manner in which pancreatic cysts are monitored is based on the anticipated risk.
  • Patients who fall into the low-risk category will undergo less frequent surveillance.
  • Patients at high risk will have more frequent surveillance based on the recommendations of our weekly multidisciplinary consensus conference.

Testing

All patients will undergo:

  • Detailed history and physical examination with a physician who specializes in managing pancreatic diseases
  • Laboratory analysis
  • Appropriate imaging studies (MRI/MRCP or CT)
  • Review at our weekly multidisciplinary consensus conference
  • In addition, many patients will also undergo an endoscopic ultrasound procedure (EUS) to obtain a sample of cyst fluid for further testing.

Surveillance of lower-risk patients

UTSW surveillance of high-risk patients who have definitive, worrisome features on imaging or fluid analysis*

*After multidisciplinary consensus conference review, patients will be seen by a surgeon in clinic for consideration of surgical resection.