European Radiology

, Volume 27, Issue 6, pp 2591–2599 | Cite as

Fate of small pancreatic cysts (<3 cm) after long-term follow-up: analysis of significant radiologic characteristics and proposal of follow-up strategies

  • Heera Yoen
  • Jung Hoon Kim
  • Dong Ho Lee
  • Su Joa Ahn
  • Jeong Hee Yoon
  • Joon Koo Han



To describe the natural history of pancreatic cysts after long-term follow-up, with an emphasis on the identifying indicators of indolent lesions.


We retrospectively sampled 95 patients with 149 cysts <3 cm detected by CT from 2003 to 2004, and followed them for more than five years (mean 117.5 ± 18.8 months). Two radiologists reviewed the initial CT images, then recorded changes after the follow-up. We compared the cysts’ initial characteristics between the surgery and non-surgery patient groups, and also between non-benign lesions and benign lesions.


Twelve of the 95 patients, who among them had 16 cysts, underwent surgery. Of the 133 cysts in the 83 nonsurgical patients, 57 cysts (42.9 %) enlarged, although only five cysts increased to larger than 3 cm at the end of observation. The initial size of the cyst was significantly larger in the surgery group than non-surgery group. Also, according to cyst-based analysis, ductal communication, dilatation, and shape correlated with those of non-benign cysts and the non-surgical group. No cysts < 15 mm and without p-duct change showed a significant change within three years.


Small pancreatic cysts, without p-duct change, and without a pleomorphic or clubbed shape, may be followed for a longer interval than current consensus.

Key Points

Almost all small cysts < 3 cm were indolent in long term observation.

No cysts < 15 mm, without p-duct change showed significant change within 3 years.

Cyst size, ductal change and shape can be useful in predicting progress.

Only cysts with IPMN- like features and p-duct change need follow-up with cautions.


Pancreatic cyst IPMN Natural history Radiologic characteristics Follow-up strategy 

Abbreviations and acronyms


Computed tomography


Ductal adenocarcinoma


Intraductal papillary mucinous neoplasm


Serous cystic neoplasm


Mucinous cystic neoplasm



We thank Bonnie Hami, M.A. (USA) for her editorial assistance in the preparation of this manuscript. The scientific guarantor of this publication is Joon Koo Han. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by

• National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIP) (No. 2009-0083512) and

• 2014 Man Chung Han research grant from the Department of Radiology, Seoul National University, College of Medicine.

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: Retrospective, observational, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  1. 1.Department of Radiology and Institute of Radiation MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Institute of Radiation MedicineSeoul National University HospitalSeoulKorea
  3. 3.Department of RadiologySeoul National University HospitalSeoulKorea

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