Assessing Surveillance Practices for Incidental Pancreatic Cystic Lesions in a Rural Community Healthcare Network

Incidental pancreatic cystic lesions (PCLs) are increasingly being detected due to the widespread use of high-resolution imaging. Certain PCL subtypes, including intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN), carry malignant potential and require guideline-directed surveillance strategies. However, real-world adherence to follow-up recommendations in community healthcare settings remains poorly defined. In this context, we aimed to describe surveillance adherence rates for incidentally detected PCLs.

This was a single-center retrospective study of consecutive adult patients who were found to have an incidental PCL between June 2017 and January 2024. The primary outcome was adherence to follow-up recommendations. Follow-up was defined as completion of repeat imaging based on radiology recommendations.

A total of 108 patients were included. The mean age was 74 ± 10 years, 59% were female, and the majority were White (84%) and retired (79%). Branch-duct IPMN was the most common cyst type (42%). Most patients had a single cyst (68%) with a mean size of 19 ± 12 mm. A history of pancreatitis was uncommon (15%), while obesity (BMI ≥ 30) was present in 49% and 56% were never smokers. Cysts were primarily detected in the outpatient setting (64%), most commonly via computed tomography (70%). Overall, 98% of patients completed surveillance imaging, and 87% had gastroenterology follow-up.

This study shows that the follow-up rate for incidentally discovered PCLs was exceptionally high. Having an established primary care provider and access to subspecialty gastroenterology services appear to be associated with higher follow-up completion.