Consensus guidelines for the management of intraductal papillary mucinous neoplasms of the pancreas

This week’s discussion included information about the utility of the Fukuoka criteria.

Srinivasan N, et al. Systematic review of the clinical utility and validity of the Sendai and Fukuoka Consensus Guidelines for the management of intraductal papillary mucinous neoplasms of the pancreas.HPB (Oxford). 2018 Jun;20(6):497-504.

Free full-text. 

RESULTS: Ten studies evaluating the FCG, 8 evaluating the SCG and 4 evaluating both guidelines were included. In 14 studies evaluating the FCG, out of a total of 2498 neoplasms, 849 were malignant and 1649 were benign neoplasms. Pooled analysis showed that 751 of 1801 (42%) FCG+ve neoplasms were malignant and 599 neoplasms of 697 (86%) FCG-ve neoplasms were benign. PPV of the high risk and worrisome risk groups were 465/986 (47%) and 239/520 (46%) respectively. In 12 studies evaluating the SCG, 1234 neoplasms were analyzed of which 388 (31%) were malignant and 846 (69%) were benign. Pooled analysis demonstrated that 265 of 802 (33%) SCG+ve neoplasms were malignant and 238 of 266 SCG-ve (90%) neoplasms were benign.

CONCLUSION: The FCG had a higher positive predictive value (PPV) compared to the SCG. However, the negative predictive value (NPV) of the FCG was slightly lower than that of the SCG. Malignant and even invasive IPMN may be missed according to both guidelines.

Tanaka M, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017 Sep – Oct;17(5):738-753.

Full-text for Emory users.

スライド 1

Fig. 2. Algorithm for the management of suspected BD-IPMN. a. Pancreatitis may be an indication for surgery for relief of symptoms. b. Differential diagnosis includes mucin. Mucin can move with change in patient position, may be dislodged on cyst lavage and does not have Doppler flow. Features of true tumor nodule include lack of mobility, presence of Doppler flow and FNA of nodule showing tumor tissue. c. Presence of any one of thickened walls, intraductal mucin or mural nodules is suggestive of main duct involvement. In their absence main duct involvement is inconclusive. Abbreviations: BD-IPMN, branch duct intraductal papillary mucinous neoplasm; FNA, fine needle aspiration.

Scholten L, et al. Pancreatic Cystic Neoplasms: Different Types, Different Management, New Guidelines. Visc Med. 2018 Jul;34(3):173-177.

Free full-text.

Table 2. Recent guidelines for the management of pancreatic cystic neoplasmsComparison PN guidelines table

More PubMed results on IPMN and MCN guidelines.

1 thought on “Consensus guidelines for the management of intraductal papillary mucinous neoplasms of the pancreas

  1. Pingback: Pancreatic Cystic Neoplasms | Surgical Focus

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s