Effect of a region-wide incorporation of an algorithm based on the 2012 international consensus guideline on the practice pattern for the management of pancreatic cystic neoplasms in an integrated health system

Table 1 Radiology report: Southern California Permanente Medical Group Guideline for Imaging Management of Pancreatic Cysts (benign-appearing cyst in asymptomatic patient)

Size of Lesion	Recommendations
1-5 mm	Too small to characterize, considered benign
	No further imaging follow-up recommended
6-9 mm	Consider single follow-up in 2-3 yr, preferably MRCP/MRI pancreas
	If stable at follow up, no further imaging follow-up recommended
1-1.9 cm	Consider follow-up MRCP/MRI or CT pancreas in 1-2 yr
	If stable at follow-up, lengthen interval imaging follow-up to 2-3 yr
2-2.9 cm	Consider baseline EUS, then follow-up MRCP/MRI or CT pancreas in 6-12 mo
	Consider surgery in young, fit patients with need for prolonged surveillance
	If stable at follow-up, lengthen interval imaging follow-up to 1-2 yr
≥ 3 cm	Consider baseline or follow-up EUS, then follow-up MRCP/MRI or CT pancreas in 3-6 mo
	Strongly consider surgery in young, fit patients

MRCP: Magnetic resonance cholangiopancreatography; MRI: Magnetic resonance imaging; CT: Computed tomography; EUS: Endoscopic ultrasound.

Table 2 Baseline characteristics n (%)

	Pre-algorithm	Post-algorithm	Total	P value
Number of patients	1157 (45.23)	1401 (54.77)	2558
Imaging at diagnosis				0.032
CT	822 (71)	958 (68.4)	1780 (69.6)
MR	215 (18.6)	317 (22.6)	532 (20.8)
Ultrasound	120 (10.4)	126 (9)	246 (9.6)
Largest dimension (mm)				0.119
Mean (SD)	19.1 (16.86)	18.5 (17.90)	18.8 (17.44)
Range	(2.0-210.0)	(0.9-204.0)	(0.9-210.0)
Age (yr)				0.013
Mean (SD)	67.1 (13.77)	68.4 (13.92)	67.8 (13.86)
Range	(20.0-95.0)	(20.0-100.0)	(20.0-100.0)
Sex				0.096
Male	396 (34.2)	524 (37.4)	920 (36)
Female	761 (65.8)	877 (62.6)	1638 (64)
Race/ethnicity				0.179
Asian	159 (13.7)	174 (12.4)	333 (13.0)
African American	129 (11.1)	126 (9.0)	255 (10.0)
Latino	270 (23.3)	370 (26.4)	640 (25)
Others/unknown	15 (1.3)	20 (1.4)	35 (1.4)
White	584 (50.5)	711 (50.7)	1295 (50.6)

CT: Computed tomography; MR: Magnetic resonance; SD: Stable disease.