PANCREATIC CYSTS
Last modified: September 13, 2025
Main reference: CAR 2021
Target population
Patients <40 years: gastroenterology consultation +/- endo ultrasound
Most cysts are inflammatory
To determine the causes of pancreatitis and need for further investigation, as cysts are rare in this younger population
Patients > 75 years : no investigation recommended immediately, but management to be adjusted according to the potential for medical or surgical intervention
Important Notes
If cyst seen on ultrasound or CT
Confirmation of the characteristics of the cyst should ideally be done by pancreatic MRI and MRCP
MRI technique
T2 acquisition: 4-6 mm slices
MRCP: sections ≤ 0.9 mm
If a new pancreatic cyst appears during follow-up (> 5 mm, without suspicious characteristics), this new lesion is considered to be the initial lesion and follow-ups must be carried out accordingly.
Additional Notes
Cyst ≤ 5 mm in its longest diameter: no follow-up
49% of patients in an autopsy series had cysts 5 mm and smaller
Risk of neoplasia: 1% over 10 years
Excludes non-simple cyst
If multiple cysts, use the largest cyst by size or morphology
Cyst ≥2.5 cm for any age: gastro consultation with endo ultrasound +/- cytology
High risk of neo-mucinous disease or sequelae of symptomatic pancreatitis
Figures
Figure 1. Original summary table of CAR recommendations for the management of pancreatic cysts for patients aged 40-49 years
ans
Figure 2. Original summary table of CAR recommendations for the management of pancreatic cysts for patients aged 50-75 years
References
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Fung CI, Bigam DL, Wong CKW, et al. Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group. Canadian Association of Radiologists Journal. 2021;73(2):312-319. doi:10.1177/08465371211021079