title: Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be intraductal papillary mucinous neoplasms.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mukewar
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Nicolo
authors.initials: N
authors.lastname: de Pretis
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Anupama
authors.initials: A
authors.lastname: Aryal-Khanal
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Nazir
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Raghuwansh
authors.initials: R
authors.lastname: Sah
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Felicity
authors.initials: F
authors.lastname: Enders
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Larson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Pearson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Santhi S
authors.initials: SS
authors.lastname: Vege
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D010181:Pancreatic Cyst / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods
keywords: PANCREATIC CANCER; PANCREATIC EPIDEMIOLOGY; PANCREATIC SURGERY; PANCREATIC TUMOURS