The role of transabdominal ultrasound in pancreatic cyst surveillance: correlation with cross-sectional imaging findings and malignancy risk

PURPOSE: This study aimed to evaluate the clinical utility of transabdominal ultrasound (TAUS) for pancreatic cyst surveillance by assessing its concordance with follow-up computed tomography (CT) and magnetic resonance imaging (MRI) findings and the associated risk of malignancy. METHODS: This retrospective study included 523 patients who underwent TAUS for pancreatic cysts (≥1 cm), followed by contrast-enhanced CT or MRI within a 1-year interval between 2021 and 2022. Cysts were classified as high-risk if they exhibited any high-risk stigmata or worrisome features, and as low-risk otherwise, based on the 2024 international consensus guidelines. TAUS classifications were compared with those from CT/MRI. In a subset of 164 patients with reference standards, malignancy rates were compared between high- and low-risk cysts on TAUS. RESULTS: The overall cyst identification rate on TAUS was 88.7% (464/523), with identification rates higher in patients with lower body mass index (23.8±3.3 kg/m2 vs. 29.2±3.3 kg/m2, P=0.003) and in those with non-tail cyst locations (92.7% [406/438] vs. 68.2% [58/85] for tail lesions, P