Cross-sectional study of prevalence and size-based risk categorization of pancreatic cysts among asymptomatic individuals with screening MRI

Subsets of pancreatic cystic lesions (PCLs) are the only radiographically evident precursors to pancreatic cancer. True prevalence of PCLs in the general population are unknown, as available data are often biased by imaging performed in symptomatic patients. In a cross-sectional study including 21,651 asymptomatic North American individuals who underwent rapid whole-body MRI, the standardized prevalence of PCLs was 6% overall and 21% in individuals aged 80 years and older. Older age, female sex, history of pancreatitis and PDAC, family history of PDAC, alcohol use, and Latin American or Middle Eastern ethnicity were associated with higher likelihood of cyst development. Almost all (99%) of lesions fell below the size threshold associated with increased malignant potential (3 cm). The authors conclude that these findings suggest that most incidental PCLs, while common, may be very low risk based on size-based risk categorization alone.