ACR Incidental Pancreatic Cyst · Pâncreas

ACR Incidental Pancreatic Cyst ACR incidental pancreatic cyst management

vigente

Management pathway for incidentally detected pancreatic cysts based on size and worrisome features.

Índice de referência, não é suporte à decisão clínica. O RadCommons apresenta conteúdo de referência reescrito a partir de critérios publicados e com link para a fonte primária. Confira sempre a publicação primária vigente. Não é um dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Escala de categorias

small-cyst intermediate-cyst large-cyst worrisome-features main-duct-involvement

As figuras e tabelas estão na fonte primária. Abrir a fonte. O RadCommons reescreve e cita, não reproduz figuras protegidas por direitos autorais.

Procedência e vigência

Órgão emissor: American College of Radiology
Versão: 2017
Ano: 2017
Família: achado incidental
Tipo de lógica: flat
Modalidade: CT, MRI
Fonte primária: Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee · doi:10.1016/j.jacr.2017.03.010
Última verificação: 2026-06-22
Última checagem: 2026-06-22

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Size thresholds, follow up intervals, and worrisome feature list pending sourcing.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "small-cyst",
    "intermediate-cyst",
    "large-cyst",
    "worrisome-features",
    "main-duct-involvement"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
small-cyst	Small cyst Incidental pancreatic cyst under 1.5 cm (the smallest size band). Patients are split into under 65 years and 65-79 years. A special subgroup is the so-called 'white dot' lesion under 5 mm on T2-weighted MRI.	Imaging surveillance (CT or MRI) for a total of about 9-10 years, terminating at age 80, with frequency by age: for patients 65 years or older, initial follow-up every 2 years; for patients under 65, initial follow-up yearly. Cysts are presumed mucinous and need not be specifically characterized at detection. If a cyst grows, increase follow-up frequency and/or consider EUS with FNA. For sub-5 mm 'white dot' lesions, a single follow-up CT or MRI at 2 years showing stability is sufficient to stop surveillance.	—	okfonte Fig. 1 (Chart 1) flowchart and its legend ('management of incidental pancreatic cysts <1.5 cm'); 'Overview of the Algorithm' (Chart 1) and 'Length of Follow-up' sections; 'Five Common Principles' principles 1-2
intermediate-cyst	Intermediate size cyst Incidental pancreatic cyst 1.5-2.5 cm (the middle size band). Stratified by whether main pancreatic duct (MPD) communication can be established (Chart 2A) or is absent/cannot be determined (Chart 2B).	If MPD communication is present (Chart 2A), follow-up is by initial size: cysts 1.5-1.9 cm are followed yearly for 5 years, then every 2 years for 4 years; cysts 2.0-2.5 cm are followed at 6-month intervals for 2 years, then yearly for 2 years, then every 2 years for 6 years. An alternative is direct EUS with FNA at detection. If MPD communication is absent or indeterminate (Chart 2B), two pathways are offered: close imaging follow-up, or EUS with FNA to establish whether the cyst is mucinous and guide management. Surveillance follows the same overall ~9-10 year horizon, ending at age 80.	—	okfonte Fig. 2 (Charts 2A and 2B) flowcharts and legend ('management of incidental pancreatic cysts 1.5-2.5 cm, when MPD communication can be established (A), and when MPD communication is absent or cannot be determined (B)'); 'Overview of the Algorithm' (Charts 2A and 2B) section
large-cyst	Large cyst Incidental pancreatic cyst larger than 2.5 cm at initial detection (the large band; this 2.5 cm threshold is the paper's chosen cutoff, deliberately lower than the commonly used 3 cm worrisome-feature threshold).	If a benign histology such as serous cystadenoma (SCA) is diagnosed by imaging or aspiration, follow-up depends on symptoms (a symptomatic SCA or one over 4 cm may need surgical removal). Otherwise evaluate for worrisome features / high-risk stigmata: low-risk cysts can be carefully followed (even if 3 cm or larger), while high-risk cysts should be sent immediately for EUS, FNA, and surgical evaluation. Any cyst should undergo EUS and FNA before resection to minimize unnecessary surgery. Pseudocysts are excluded (usually symptomatic).	—	okfonte Fig. 3 (Chart 3) flowchart and legend ('management of incidental pancreatic cysts >2.5 cm'); 'Overview of the Algorithm' (Chart 3) section; 'Five Common Principles' principle 2
worrisome-features	Worrisome features present Worrisome features (Table 1): cyst 3 cm or larger; thickened/enhancing cyst wall; nonenhancing mural nodule; MPD caliber of 7 mm or greater (the paper recommends a simplified 7 mm threshold rather than the Fukuoka 5-9 mm range). High-risk stigmata (Table 1): obstructive jaundice with a cyst in the pancreatic head; an enhancing solid component within the cyst; MPD caliber of 10 mm or greater in the absence of obstruction.	Development or presence of worrisome features or high-risk stigmata should prompt EUS with FNA and surgical consultation. Exception: a cyst 3 cm or larger with no other worrisome features or high-risk stigmata may alternatively be followed. A mural nodule is suspicious even if the cyst does not grow.	—	okfonte Table 1 ('Worrisome features and high-risk stigmata'); 'Reporting Considerations' item 4 ('Presence of Worrisome Features and/or High-risk Stigmata'); 'Five Common Principles' principle 4
main-duct-involvement	Main pancreatic duct involvement Main pancreatic duct (MPD) dilation or cyst-MPD communication. A simplified MPD dilation threshold of 7 mm or greater is a worrisome feature, and MPD of 10 mm or greater without other cause of obstruction is a high-risk stigma. Cyst communication with the MPD defines a branch-duct (or combined) IPMN; communication is established with CT/3D reconstructions or MRI/MRCP (equivalent to EUS).	A dilated MPD is a suspicious feature in BD-IPMN and should be investigated immediately by EUS and FNA to determine further management. The widest MPD diameter should be recorded for all BD-IPMN even if away from the cyst. When duct communication can be established for 1.5-2.5 cm cysts, slightly less aggressive (size-based) surveillance is followed (Chart 2A) versus the indeterminate pathway (Chart 2B).	—	okfonte Table 1 (MPD 7 mm worrisome; MPD 10 mm high-risk stigma); 'Reporting Considerations' item 3 ('Relation to Main Pancreatic Duct') and item 4; Fig. 2 (Charts 2A/2B)

Referências cruzadas

fronteira compartilhadaACR Incidental Adrenal. ACR incidental adrenal mass managementBoth are ACR Incidental Findings Committee white papers in the same series.

Histórico de versões

Data	Evento	Detalhe	Situação
2017-07-01	published	ACR Incidental Findings Committee pancreatic cyst white paper published. evidência	confirmado

Quickstart da APIGET /api/v1/systems/acr-incidental-panc-cyst-2017aberto

curl -s "https://radcommons.laudos.ai/api/v1/systems/acr-incidental-panc-cyst-2017"

Ver documentação completa →