Consensus recommendations from the Danish Pancreatic Cancer Group, published in Acta Radiologica on 1 September, set out a pragmatic approach to intraductal papillary mucinous neoplasms (IPMNs), the commonest incidental pancreatic cysts. A working group of radiologists and pancreatic surgeons based them on a narrative review, existing international guidelines and experience in a centralised system, without a formal Delphi process.
MRI with MRCP is the primary modality for diagnosis and follow-up, with CT and endoscopic ultrasound used selectively. Risk is judged on high-risk stigmata and worrisome features, with weight on change between scans. Surveillance intervals are mainly size-based and adjusted for age, comorbidity and fitness for surgery. Surgical evaluation is recommended for cysts larger than 30 mm and for main-duct or mixed-type IPMNs with high-risk features; branch-duct lesions are managed more selectively. Stopping surveillance is supported in selected patients whose cysts are stable, particularly older patients.
The practice change for radiologists is in the report: naming the follow-up modality, the interval, and — for an older patient with a long-stable cyst — the possibility that surveillance can end. International guidelines still differ on when to stop, so this is a reasoned option, not a universal rule, and it depends on a multidisciplinary decision.
- Use MRI with MRCP as the default for characterising and following a suspected IPMN.
- Report size, main-duct involvement, high-risk stigmata and worrisome features, and change since the last scan.
- Flag cysts over 30 mm and main-duct or mixed-type lesions with high-risk features for surgical review.
- For an older or frail patient with a long-stable cyst, suggest discussion of stopping surveillance.
- Recommend multidisciplinary review where guidelines conflict.
Why it matters
Lifelong surveillance of indolent cysts costs patients scans, anxiety and sometimes needless surgery.
Don't overread it
This is a national consensus without a formal Delphi process; international guidelines still disagree on stopping surveillance.
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