Objective To retrospectively study the correlation between pre-operative morphological and biochemical features of resected pancreatic cystic lesions and predictive power of these features in relation to biological behaviour and final histology. Methods We reviewed the literature systematically to identify relevant variables that are in use to predict the biological nature of pancreatic cystic lesions and aid therapeutic planning. We designed a template encompassing all used variables to collate the available data of resected pancreatic cystic lesions from two centres. The collated data included clinico-pathological and biochemical data, pre-operative computed tomography, magnetic resonance imaging, Endoscopic ultrasound, positron emission tomography–computed tomography, Fine-needle aspiration analysis whenever available and correlated with the final post-operative histology. Pooled data was analysed using statistics and data 14 statistical software. Results Sixty-four patients with pre-operative diagnosis of pancreatic cystic lesions were identified. Twenty seven cases underwent endoscopic ultra sound - fine-needle aspiration as an adjunct to the radiological assessment to evaluate the nature of these noted PCLs and both cytological and biochemical analysis were carried out on the intra-cystic aspirate. The intra cystic carcinoembryonic antigen levels recorded a mean of 667.97 in the tested group with a standard deviation of 1934.38. Conclusion No single test is able to predict the nature or behaviour of pancreatic cystic lesions. The differences noted on specialist imaging can be very subtle and demand specialist interpretive skills and hence a panel of pre-operative testing with review at specialist multidisciplinary meeting is mandatory for all such cases.