The purpose of this retrospective multicenter study was to determine if Integrated Molecular Pathology (IMP) testing of pancreatic cysts, also known as PancraGEN, influenced real-world patient management decisions. Decisions to observe patients with cysts or surgically intervene were examined based on IMP test results and based on the International Consensus Guideline (ICG) criteria for patient management. When patients met ICG clinical criteria for surveillance but IMP results indicated high risk of malignancy, 88% of patients received intervention for their cysts in real life, demonstrating that high-risk IMP results were predictive of decisions to surgically intervene even when patients met clinical criteria for observation. Importantly, these decisions to intervene rather than observe patients benefited patient outcomes, as 57% of patients had malignant outcomes. Conversely, when patients met ICG surgical criteria but IMP results indicated low risk of malignancy, 55% of patients underwent surveillance for their cysts in real life, demonstrating that low-risk IMP results were predictive of decisions to observe rather than resect pancreatic cysts even when patients met clinical criteria for surgery. Importantly, these decisions to observe rather than resect benefited the vast majority of patients, as 99% had benign outcomes at a median of ~3 years’ follow-up. The study concluded that real-world decisions to resect or observe pancreatic cysts were highly associated with initial IMP diagnostic recommendations, which were beneficial to patient outcomes.