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Risk-stratified surveillance

Pancreatic Cystic Lesions · Kyoto 2024 (IAP) / ACR structured report

Structured reporting for diagnosis, risk stratification, differential diagnosis, and age-stratified surveillance. Kyoto 2024 HRS/WF, Fukuoka 2017 cross-reference, ACR incidental findings elements, and Han et al. (JAMA Surgery 2024) optimal intervals evaluated automatically.

Kyoto 2024 risk tier
Low risk
Low probability of malignancy
0 cysts · largest —
HRS: 0
WF: 0
Cysts
0
Largest
—
MPD
—
HRS
0
WF
0
Risk tier
low
Low probability of malignancy
Favored dx
Indeterminate cystic lesion
CA 19-9
—
Next imaging
12 months
Indication
Age (yrs)
CA 19-9 (U/mL)
CEA serum (ng/mL)
Lipase/Amylase
HbA1c (%)
Prior pancreatitis
New-onset diabetes

Kyoto 2024 worrisome feature.

Obstructive jaundice

High-risk stigma when a head/uncinate cyst is present.

Family hx PDAC
Prior study date
Prior modality
Prior findings
Prior EUS/FNA
Modality
Technical adequacy
Secretin administered
Parenchymal morphology
MPD max (mm)
CBD (mm)
MPD morphology
Abrupt MPD caliber change + distal atrophy

Kyoto 2024 worrisome feature.

CBD dilated
Ampulla

Add up to 5 discrete cysts; summarize the remainder in comparison.

Location
Size (mm)
Morphology
Septations
Thickened enhancing wall

Kyoto worrisome feature.

Calcifications
Ductal communication

Critical differential feature.

Mural nodule
Signal / new lesion
Growth (mm/yr)

High-risk stigmata (HRS) and worrisome features (WF). Kyoto 2024 adds suspicious/positive cytology (HRS), growth ≥2.5 mm/yr and new-onset diabetes (WF).

High-risk stigmata
0 present
Worrisome features
0 present
Stepwise malignancy risk (Zelga et al. 2022, n=810 IPMN): 22% (1 WF), 34% (2 WF), 59% (3 WF), ~100% (≥4 WF). Any HRS ~70% malignancy in surgical series.
Favored diagnosis
Diagnostic confidence

If EUS/FNA performed. Combined CEA ≥192 and glucose ≤50 achieves ~92% specificity for mucinous cysts.

Fluid CEA (ng/mL)
Fluid glucose (mg/dL)
Fluid amylase (U/L)
Cytology
KRAS/GNAS
Liver metastases
Regional lymphadenopathy

Kyoto 2024 worrisome feature.

Peritoneal disease
Vascular involvement
Other findings

Han et al. JAMA Surgery 2024 intervals · ACR age-stratified adjustments · Kyoto 2024 escalation rules.

Recommended interval
12 months
Abbreviated non-contrast MRI/MRCP acceptable
Discontinuation eligibility
Not eligible
Final impression banner

Solitary Indeterminate cystic lesion; low risk (0 HRS, 0 WF).

Auto-generated impression
• Favored diagnosis: Indeterminate cystic lesion with recommendation: surveillance Abbreviated non-contrast MRI/MRCP acceptable in 12 months.
• No discrete pancreatic cystic lesion characterized.
• Ductal communication not characterized.
• No high-risk stigmata.
• No worrisome features.
• Risk tier: low — Low probability of malignancy.
Recommended next steps
  • Complete characterization to generate recommendations.