Ohno E, et al. - By using mid-term follow-up analysis of a multicenter prospective observational study (NSPINAL study), the authors explain the natural history of pancreatic cystic lesions (PCLs), including branch-duct intraductal papillary mucinous neoplasm (BD-IPMN). Malignant progression of PCLs is not uncommon, including pancreatic cancer (PC) development. To detect pancreatic ductal adenocarcinoma (PDAC) at early stages, patients with PCLs should be carefully monitored.