title: Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer.
abstract: BACKGROUND
  The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria").
  
  
  METHODS
  Retrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).
  
  
  RESULTS
  After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001).
  
  
  CONCLUSIONS
  This study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk.
authors.affiliation: Department of Gastroenterology, Naval Medical Center, San Diego, California (Robert D. Lawson).
authors.forename: Robert D
authors.initials: RD
authors.lastname: Lawson
authors.affiliation: Department of Gastroenterology, Kaiser Permanente, San Diego, California (Gordon C. Hunt).
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Hunt
authors.affiliation: Department of Gastroenterology, Kaiser Permanente, Anaheim, California (Andrew Q. Giap).
authors.forename: Andrew Q
authors.initials: AQ
authors.lastname: Giap
authors.affiliation: Department of Gastroenterology, Veterans Affairs Medical Center, La Jolla, California (Mary L. Krinsky).
authors.forename: Mary L
authors.initials: ML
authors.lastname: Krinsky
authors.affiliation: Department of Gastroenterology, Department of Research and Evaluation, Kaiser Permanente, Pasadena, California (Jeff Slezak).
authors.forename: Jeff
authors.initials: J
authors.lastname: Slezak
authors.affiliation: Department of Gastroenterology, Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (Raymond S. Tang).
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Tang
authors.affiliation: Department of Gastroenterology, Digestive Health Specialists, Winston-Salem, North Carolina (Ingrid Gonzalez).
authors.forename: Ingrid
authors.initials: I
authors.lastname: Gonzalez
authors.affiliation: Department of Gastroenterology, Division of Gastroenterology, University of California, La Jolla, California (Wilson T. Kwong, Sayed A. Fehmi, Thomas J. Savides).
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Kwong
authors.affiliation: Department of Gastroenterology, Division of Gastroenterology, University of California, La Jolla, California (Wilson T. Kwong, Sayed A. Fehmi, Thomas J. Savides).
authors.forename: Syed A
authors.initials: SA
authors.lastname: Fehmi
authors.affiliation: Department of Gastroenterology, Division of Gastroenterology, University of California, La Jolla, California (Wilson T. Kwong, Sayed A. Fehmi, Thomas J. Savides).
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
keywords: Pancreatic cyst; endosonography; intraductal papillary mucinous neoplasm; natural history; pancreatic cancer