Pancreatic Cysts Associated with Intraductal Papillary Mucinous Neoplasms May Be Safely Monitored with Imaging

Choubey AP, Alessandris R, Armstrong MT, et al. Natural History of Pancreatic Cyst with Diameter as the Solitary Risk Factor. J Am Coll Surg. 2025; in press.

Clinical practice guidelines recommend that patients with pancreatic cysts associated with intraductal papillary mucinous neoplasms (IPMN) should be referred for surgery if cyst diameter exceeds 3 cm or there are other features that suggest progression to malignancy.

This retrospective review of 89 patients from a single institution provided data on rates of cyst progression necessitating surgery in patients who had IPMN-associated pancreatic cysts with a median diameter of 3.5 cm as the only indication for surveillance or intervention at the time of enrollment.

Patients were followed with imaging surveillance for a total of 85.7 months. Cumulative rates of progression ranged from 3.4% at 3 months of follow up to 13.7% at 57 months. Resection was performed in 13 patients and no evidence of pancreatic cancer or high-grade dysplasia was found on pathologic examinations.

The authors concluded that patients with pancreatic cysts with diameter >3 cm as the only worrisome feature could be safely monitored with imaging.