title: Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients.
abstract: BACKGROUND
  The Sendai Consensus Guidelines (SCG) were formulated in 2006 and updated in Fukuoka in 2012 (FCG) to guide management of cystic mucinous neoplasms of the pancreas. This study aims to evaluate the clinical utility of the SCG and FCG in the initial triage of all suspected pancreatic cystic neoplasms.
  
  
  METHODS
  Overall, 317 surgically-treated patients with a suspected pancreatic cystic neoplasm were classified according to the SCG as high risk (HR(SCG)) and low risk (LR(SCG)), and according to the FCG as high risk (HR(FCG)), worrisome (W(FCG)), and low risk (LR(FCG)). Cystic lesions of the pancreas (CLP) were classified as potentially malignant/malignant or benign according to the final pathology.
  
  
  RESULTS
  The presence of symptoms, proximal lesions with obstructive jaundice, elevated serum carcinoembryonic antigen/carbohydrate antigen 19-9 (CEA/CA 19-9), size ≥3 cm, presence of solid component, main pancreatic duct dilatation, thickened enhancing walls, and change in ductal caliber with distal atrophy were predictive of a potentially malignant/malignant CLP on univariate analyses. The positive predictive value (PPV) and negative predictive value (NPV) of HR(SCG) and HR(ICG2012) for a potentially malignant/malignant lesion was 67 and 88 %, and 88 and 92.5 %, respectively. There were no malignant lesions in both LR groups but some potentially malignant lesions such as cystic pancreatic neuroendocrine neoplasms with uncertain behavior were classified as LR.
  
  
  CONCLUSIONS
  The updated FCG was superior to the SCG for the initial triage of all suspected pancreatic cystic neoplasms. CLP in the LR(FCG) group can be safely managed conservatively, and those in the HR(FCG) group should undergo resection.
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore, bsgkp@hotmail.com.
authors: Brian K P
authors: BK
authors: Goh
authors: Damien M Y
authors: DM
authors: Tan
authors: Choon-Hua
authors: CH
authors: Thng
authors: Ser-Yee
authors: SY
authors: Lee
authors: Albert S C
authors: AS
authors: Low
authors: Chung-Yip
authors: CY
authors: Chan
authors: Jen-San
authors: JS
authors: Wong
authors: Victor T W
authors: VT
authors: Lee
authors: Peng-Chung
authors: PC
authors: Cheow
authors: Pierce K H
authors: PK
authors: Chow
authors: Alexander Y F
authors: AY
authors: Chung
authors: Wai-Keong
authors: WK
authors: Wong
authors: London L P J
authors: LL
authors: Ooi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D004108:Dilatation, Pathologic / Q000473:pathology; D019160:Endosonography; D005260:Female; D006801:Humans; D007564:Japan; D041781:Jaundice, Obstructive / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014218:Triage; D055815:Young Adult
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen