Although pancreatic cystic lesions (PCLs) are frequently and incidentally detected, it is a challenge to determine their risk of malignancy. In immunohistochemical and ELISA analyses of tissue and cyst fluid from pancreatic intraductal papillary mucinous neoplasms (IPMNs), the monoclonal antibody Das-1 identifies those at risk for malignancy with high levels of specificity and sensitivity. We aimed to validate the ability of Das-1 to identify high-risk PCLs, in comparison to clinical guidelines and clinical features, using samples from a multicenter cohort.