The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines

We aimed to determine incidental pancreatic cyst ("cyst") surveillance patterns, predictors of receiving surveillance, and guideline adherence.

We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010-2011). All follow-up care was abstracted over a 5-year period.

Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9-119) and recommending follow-up (OR, 5.5; 95% CI, 2.1-13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3-89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1-10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline.

Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.