Advanced diagnostics for pancreatic cysts: Confocal endomicroscopy and molecular analysis

Table 2 Treatment and surveillance guidelines for pancreatic cysts

Guideline	Recommendations
Sendai 2006 [8]	Recommended surgical resection if any of the following lesions were suspected:
	MCNs
	Main duct IPMNs
	Mixed duct IPMNs
	Also recommended surgical resection also based on:
	Clinical symptoms
	Dilated pancreatic duct (≥6mm)
	Intracystic mural nodules
	Positive cytology [8]
Fukuoka 2012 [6]	Recommended surgical resection for high-risk criteria:
	Dilated pancreatic duct (≥10mm)
	Presence of an enhancing solid component
	Obstructive jaundice [6]
American Gastroenterological Association (AGA) 2015 [9]	Recommended EUS-FNA if 2 out of 3 of the following high-risk features were present:
	Size ≥ 3 cm
	Dilated main pancreatic duct
	Solid component
	Recommended surgical resection if a cyst had both of the following:
	Solid component
	Dilated pancreatic duct and/or concerning features on EUS-FNA [9]
Fukuoka 2017 [7]	Enhancing mural nodule is a high risk feature if measuring ≥ 5 mm
	Added surveillance guidelines for BD-IPMN, noting presence of lymphadenopathy, increased serum CA19-9 and cyst growth rate >5 mm in diameter over 2 years as “worrisome features” [7]

MCN: Mucinous cystic neoplasm; IPMN: Intraductal papillary mucinous neoplasm; BD-IPMN: Branched duct intraductal papillary mucinous neoplasm; EUS: Endoscopic ultrasound; FNA: Fine needle aspiration.