title: Evaluation of the Fukuoka Consensus Guidelines for intraductal papillary mucinous neoplasms of the pancreas: Results from a systematic review of 1,382 surgically resected patients.
abstract: BACKGROUND
  International consensus guidelines to guide management of intraductal papillary mucinous neoplasms (IPMN) were revised in Fukuoka and published in 2012. However, despite widespread acceptance of the Fukuoka Consensus Guidelines (FCG), the utility of these guidelines have not been well-validated. This systematic review was performed to evaluate the clinical utility of the FCG.
  
  
  METHODS
  A computerized search of the PubMed and Scopus databases was performed to identify all studies evaluating the utility of the FCG in surgically resected IPMN. IPMN were stratified according to the FCG as high risk (HR), worrisome risk (WR), and low risk (LR). HR and WR IPMN were termed FCG+ve and LR IPMN were termed FCG-ve.
  
  
  RESULTS
  Seven studies analyzing 1,382 patients were included. There were 402 malignant neoplasms (29%), including 242 invasive IPMNs. There were 1,000 IPMN classified as FCG+ve. The FCG+ve group had a positive predictive value (PPV) ranging from 27 to 62% and the FCG-ve group had negative predictive value ranging from 82 to 100%. Pooled analysis demonstrated that there was 362 of 1,000 (36%) malignant FCG+ve IPMN and 342 of 382 (90%) benign FCG-ve IPMN. PPV of the HR group and the WR groups alone were 104 of 158 (66%) and 75 of 261 (29%), respectively. Forty of 382 (11%), including 22 (6%) invasive FCG-ve IPMN, were malignant. Twenty-six malignant including 18 invasive FCG-ve IPMN were reported from a single study. When the results from this study were excluded, there were only 14 of 241 malignant neoplasms (6%), including 4 of 241 (2%) invasive FCG-ve IPMN in the remaining 6 studies.
  
  
  CONCLUSIONS
  The FCG+ve criteria had a similarly low PPV compared with the 2006 consensus criteria. Stratification of IPMN into HR and WR groups resulted in a higher PPV in the HR group. Some malignant and even invasive IPMN may be missed by the FCG criteria.
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore. Electronic address: bsgkp@hotmail.com.
authors.forename: Brian K P
authors.initials: BK
authors.lastname: Goh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
authors.forename: Damien M Y
authors.initials: DM
authors.lastname: Tan
authors.affiliation: Department of Oncologic Imaging, National Cancer Center Singapore, Singapore.
authors.forename: Choon-Hua
authors.initials: CH
authors.lastname: Thng
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Khor
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore.
authors.forename: Tony K H
authors.initials: TK
authors.lastname: Lim
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: London L P J
authors.initials: LL
authors.lastname: Ooi
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Alexander Y F
authors.initials: AY
authors.lastname: Chung
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000628:therapy; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000628:therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment