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An update of the 2018 Chicago consensus guidelines was conducted with a modified Delphi technique, which encompassed two rounds of voting. The levels of agreement for various pathway blocks were assessed. Of 101 participants responding in the first round of modified Delphi voting, 95 (94%) responded in the second round. Over 90% consensus was achieved in five of six and six of six pathway blocks in rounds 1 and 2, respectively. Observation was recommended for benign neoplasms, with guidance for interventions in the presence of symptoms or concerning clinicopathological features. For malignant pathology, management was outlined on the basis of a multidisciplinary assessment of patient characteristics, disease histology, and predictive success of medical and surgical interventions. Additional emphasis was placed on multimodal therapy for intermediate\u2010risk and appropriate high\u2010risk patients. 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