PT  - JOURNAL ARTICLE
AU  - Mukewar, Saurabh
AU  - de Pretis, Nicolo
AU  - Aryal-Khanal, Anupama
AU  - Ahmed, Nazir
AU  - Sah, Raghuwansh
AU  - Enders, Felicity
AU  - Larson, Joseph J
AU  - Levy, Michael J
AU  - Takahashi, Naoki
AU  - Topazian, Mark
AU  - Pearson, Randall
AU  - Vege, Santhi S
AU  - Chari, Suresh T
TI  - Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be intraductal papillary mucinous neoplasms
AID  - 10.1136/gutjnl-2016-311615
DP  - 2017 Oct 01
TA  - Gut
PG  - 1811--1817
VI  - 66
IP  - 10
4099  - http://gut.bmj.com/content/66/10/1811.short
4100  - http://gut.bmj.com/content/66/10/1811.full
SO  - Gut2017 Oct 01; 66
AB  - Objective Fukuoka consensus guidelines classify pancreatic cystic lesions (PCLs) presumed to be intraductal papillary mucinous neoplasms (IPMNs) into Fukuoka positive (FP) (subgroups of high-risk (HR) and worrisome features (WFs)) and Fukuoka negative (FN) (non-HR feature/WF cysts). We retrospectively estimated 5-year risk of pancreatic cancer (PC) in FN, WF and HR cysts of patients with PCL-IPMN.Design From Mayo Clinic databases, we randomly selected 2000 patients reported to have a PCL; we excluded inflammatory or suspected non-IPMN cysts and those without imaging follow-up. We re-reviewed cross-sectional imaging and abstracted clinical and follow-up data on PCL-IPMNs. The study contained 802 patients with FN cysts and 358 with FP cysts.Results Patients with PCL-IPMN had median (IQR) follow-up of 4.2 (1.8–7.1) years. Among FN cysts, 5-year PC risk was low (2–3%) regardless of cyst size (p=0.67). After excluding events in the first 6 months, 5-year PC risk remained low (0–2%) regardless of cyst size (p=0.61). Among FP cysts, HR cysts (n=66) had greater 5-year PC risk than WF cysts (n=292) (49.7% vs 4.1%; p<0.001). In HR cysts, 3-year PC risk was greatest for obstructive jaundice versus enhancing solid component or main pancreatic duct >10 mm (79.8% vs 37.3% vs 39.4%, respectively; p=0.01).Conclusions Fukuoka guidelines accurately stratify PCL-IPMNs for PC risk, with FN cysts having lowest and HR cysts having greatest risk. After 6-month follow-up, WF and FN cysts had a low 5-year PC risk. Surveillance strategies should be tailored appropriately.