Major Pancreatic Cyst Guidelines Show Modest, Similar Long-Term Malignancy Prediction Accuracy Using Radiology Features Alone

Major pancreatic cyst guidelines had modest long-term malignancy prediction using radiologic features alone (Kyoto AUROC 0.655, ACR 0.639, European 0.623; p<0.001). High-risk classification was concordant; after 5 years of imaging stability, 8-year cancer incidence was 0.71%.

• Kyoto guideline had slightly higher AUROC for 5-year malignancy prediction (0.655) versus ACR (0.639) and European (0.623) (p<0.001).
• High-risk classification was fully concordant across all three guidelines; worrisome feature assignment varied but 5-year cancer incidence remained similar (10.3–11.7%).
• Among 1,830 patients with 5 years of imaging stability, 8-year cancer incidence was 0.71% overall and 0.46% in those meeting Kyoto discontinuation criteria.

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