Pancreatic cystic lesions: position paper of the SIRM-AISP multidisciplinary group

Pancreatic cystic lesions represent an increasingly common clinical finding due to the widespread use of cross sectional imaging, encompassing a heterogeneous spectrum ranging from benign entities to premalignant and malignant neoplasms. Their rising incidence poses significant challenges in diagnosis, risk stratification, and management, requiring a careful balance between avoiding unnecessary interventions and preventing malignant progression. This position paper, developed by an intersocietal multidisciplinary panel of experts in pancreatic disease, aims to provide a comprehensive and evidence-based overview of these lesions. Current classifications, imaging features, and differential diagnosis are discussed, with particular emphasis on the role of magnetic resonance imaging. Key entities including serous cystic neoplasms, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and rarer cystic tumors are analyzed in terms of biological behavior and radiological characteristics. Furthermore, the document reviews available international guidelines and proposes a pragmatic approach to clinical management, including indications for surveillance, endoscopic evaluation, and surgical treatment. Special attention is given to risk stratification based on high-risk stigmata and worrisome features, as well as to individualized patient management. In conclusion, this paper provides a shared expert perspective to support standardized and personalized management of pancreatic cystic lesions in clinical practice.