Table 2. Risk stratification of pancreatic cyst in different guidelines.

	Fukouka guidelines 1	European guidelines 2	AGA guidelines 3
High-risk features (Fukouka) Or Absolute indication for surgery (European) Or Predictive of malignancy (AGA)	Mucinous cystic neoplasms (MCN) or IPMN with either: Obstructive jaundice with PCN in head of pancreas MPD dilation ≥ 1 cm Enhancing solid nodules Positive cytology	Positive cytology for malignancy of HGD Solid mass Tumor related obstructive jaundice Enhancing mural nodules ( ≥ 5 mm) MPD dilation ≥ 10 mm	Cyst > 3 cm Solid component associated with the cyst and Dilated MPD (no size criteria)
Worrisome features (Fukouka) Or Relative indication for surgery (European)	Cyst diameter ≥ 3 cm Thickened enhanced cyst walls Non-enhanced mural nodules MPD size of 5 to 9 mm Abrupt change in the MPD caliber with distal pancreatic atrophy Lymphadenopathy	Cystic growth rate ≥ 5 mm/year Increased level of serum CA 19.9 (> 37 U/mL) Symptoms Enhancing mural nodules (< 5 mm) And/or a cyst diameter  ≥ 40 mm are features of increased risk of malignancy

AGA, American Gastroenterological Association; MCN, mucinous cystic neoplasm; IPMN, intraductal papillary mucinous tumor; PCN, pancreatic cystic neoplasm; MPD, main pancreatic duct dilation; HGD, high-grade dysplasia; CA, calcium.