Once a pancreatic cyst has been characterized on a dedicated baseline examination, subsequent follow-up may be performed with either CT or MRI. There is no evidence to suggest that MRI is superior to CT for detection of new or developing worrisome features or pancreatic ductal adenocarcinoma, and cysts that change at follow up typically do so by increasing size, which is well assessed by either modality [7], although modality concordance between baseline and follow-up examinations may facilitate comparison. For CT follow-up, a dual-phase contrast-enhanced pancreatic protocol CT, including late arterial and portal venous phases, should be performed [7,8]. The frequency and duration of follow-up is controversial and depends on multiple factors, including patient age, family history of pancreatic ductal adenocarcinoma, cyst size, and whether or not there has been prior surgical resection of a pancreatic cyst. For patients with a nonspecific pancreatic cyst without a history of prior surgery, the surveillance plan will depend upon patient age and the cyst size. Follow-up intervals are generally in the range of 6 months to every 2 years for a minimum of 5 to 10 years [7-9]. Development of high-risk stigmata or worrisome features during the surveillance period should prompt EUS-FNA or surgical evaluation. For patients with a previous history of surgery for IPMN or invasive MCN without residual disease, continued surveillance is recommended, in view of the small yearly risk of pancreatic ductal adenocarcinoma of 0.7% to 0.9% [8]. For patients with known IPMN in the remnant pancreas, residual IPMN at the surgical margins, or new postoperative recurrence of IPMN, surveillance recommendations are less well defined [8]. To date, there is no evidence basis for the recommended size threshold to follow-up cysts. Based on limited clinical and published experience, a cyst <5 mm may require one follow-up CT or MRI at 2 years. Demonstrating stability at 2 years is sufficient to stop surveillance.
Pancreatic Cyst. Once a pancreatic cyst has been characterized on a dedicated baseline examination, subsequent follow-up may be performed with either CT or MRI. There is no evidence to suggest that MRI is superior to CT for detection of new or developing worrisome features or pancreatic ductal adenocarcinoma, and cysts that change at follow up typically do so by increasing size, which is well assessed by either modality [7], although modality concordance between baseline and follow-up examinations may facilitate comparison. For CT follow-up, a dual-phase contrast-enhanced pancreatic protocol CT, including late arterial and portal venous phases, should be performed [7,8]. The frequency and duration of follow-up is controversial and depends on multiple factors, including patient age, family history of pancreatic ductal adenocarcinoma, cyst size, and whether or not there has been prior surgical resection of a pancreatic cyst. For patients with a nonspecific pancreatic cyst without a history of prior surgery, the surveillance plan will depend upon patient age and the cyst size. Follow-up intervals are generally in the range of 6 months to every 2 years for a minimum of 5 to 10 years [7-9]. Development of high-risk stigmata or worrisome features during the surveillance period should prompt EUS-FNA or surgical evaluation. For patients with a previous history of surgery for IPMN or invasive MCN without residual disease, continued surveillance is recommended, in view of the small yearly risk of pancreatic ductal adenocarcinoma of 0.7% to 0.9% [8]. For patients with known IPMN in the remnant pancreas, residual IPMN at the surgical margins, or new postoperative recurrence of IPMN, surveillance recommendations are less well defined [8]. To date, there is no evidence basis for the recommended size threshold to follow-up cysts. Based on limited clinical and published experience, a cyst <5 mm may require one follow-up CT or MRI at 2 years. Demonstrating stability at 2 years is sufficient to stop surveillance.