Objectives Incidental pancreatic cystic lesion (PCL) prevalence is approximately 10%. PCL surveillance is required because a small subset have malignant potential. While several surveillance guidelines exist, utilization is variable. The Canadian Association of Radiologists Incidental Findings Working Group recently published guidelines intending to simplify and create cost-effective recommendations without compromising patient care. The purpose of this study was to calculate uptake and cost savings of these new CAR guidelines (CARG) in comparison to American Gastroenterology Association guidelines (AGAG) and American College of Radiology guidelines (ACRG).

Methods This is a multicenter retrospective study of abdominal MRIs completed one-year after a single health zone’s CARG implementation. MRIs completed during one year were reviewed to identify those with PCL. Radiology reports were reviewed for appropriate CARG recommendations. Total costs, including MRI and subspecialty consultation, associated with surveillance based on CARG, AGAG, and ACRG were compared.

Results 6,698 abdominal MRIs were reviewed with 1,001 (14.9%) identifying PCL. When PCLs were identified, 44.8% of reports provided CARG recommendations. The total cost of surveillance for 10-years for each guideline was $482,268, $1,894,745, and $1,901,237 for CARGs, AGAGs, and ACRGs respectively. Cost savings are recognized through fewer MRIs, while consultations may increase. CARGs can potentially save $1.4 million (CDN) in a single health zone over ten-years and increase MRI access.

Conclusions Recently published CARGs offer substantial cost and opportunity savings for PCL surveillance. These findings support implementation of these guidelines with close monitoring of consultation requirements and missed diagnoses.