Typical Pancreatic Serous Cystadenomas: Should We Recommend Surgical Consultation for Asymptomatic Patients with Large Lesions?

BACKGROUND: Gastroenterological guidelines consider pancreatic serous cystadenomas (SCAs) to have minimal malignant potential and generally do not recommend intervention or surveillance. In contrast, the American College of Radiology recommends surgical consultation for large SCAs (> 4 cm). OBJECTIVES: To evaluate the association between initial SCA size and lesion growth during follow-up. METHODS: The final reports of all patients who underwent magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) at our institution between the years 2011 and 2021 were reviewed for the diagnosis of serous cystadenoma. Patients with typical microcystic serous cystadenomas who had at least two MRCP examinations were included. We collected clinical data from the patients during the follow-up period, including history, symptoms, and laboratory results. The primary and maximal cyst size diameters and additional radiological characteristics were collected. RESULTS: Our cohort included 35 patients (21 females, 14 males) with a median age of 68 years. The median follow-up period was 32 months. None of our patients developed malignant transformation. Nineteen lesions grew during follow-up. We found no connection between the lesion size at presentation and the enlargement during follow-up. In total, 21 patients had smaller lesions < 4 cm and 14 had larger lesions > 4 cm. There were no significant clinical or radiological differences between the smaller and larger lesions. CONCLUSIONS: We investigated whether the current radiological recommendations for serous cystadenomas should be revised. Surgical consultation may not be needed for typical asymptomatic SCAs, regardless of the size.