title: Dynamics of Fukuoka Criteria and Patient Management in Pancreatic Intraductal Papillary Mucinous Neoplasms (IPMNs) During Follow-Up.
abstract: BACKGROUND Pancreatic intraductal papillary mucinous neoplasms (IPMNs) present a clinical challenge. Evidence-based guidelines are lacking. The so-called "Fukuoka criteria" were developed to assess the risk of malignancy in IPMNs upon imaging. However, little is known about their diagnostic value and the natural course of IPMNs. Thus, the aim of this study was the assessment of Fukuoka criteria and patient management in pancreatic IPMNs -during follow-up. MATERIAL AND METHODS IPMNs were identified via retrospective survey of endoscopic ultrasound (EUS) examinations. Fukuoka criteria were assessed on EUS findings and additional imaging (CT, MRI, ultrasound). Patients' symptoms and comorbidities were recorded. Dynamics of Fukuoka criteria and patient management were compared at first presentation and during follow-up. RESULTS We screened 1324 EUS examinations. Sixty-five patients (male/female, 14/37; mean age, 68.8 years; range, 48-85 years) with IPMNs were identified (57 branch duct (BD-)IPMNs, 3 main duct (MD-) IPMNs, 5 mixed-type (MT)-IPMNs). Seven patients received surgical resection (4 BD-IPMNs, 2 MD-IPMNs, 1 MT-IPMN). Nine BD-IPMNs had neither surgery nor follow-up. Fifty-one patients (44 BD-IPMNs, 2 MD-IPMNs, 5 MT-IPMNs) underwent follow-up (mean duration, 18.7 months; range, 3-139 months). There were 15/51 patients who were initially Fukuoka-positive. One MD-IPMN, 4/5 MT-IPMNs, and 13/44 BD-IPMNs showed progressive changes but were not resected due to patients' refusal or comorbidities. Four BD-IPMNs converted to Fukuoka-positive. CONCLUSIONS Evidence-based guidelines for non-invasive dignity assessment of IPMNs are lacking. In our study, MD-IPMNs displayed greater dynamics than BD-IPMNs and MT-IPMNs concerning Fukuoka criteria. Prospective long-term studies are needed to clarify prognostic significance of the single Fukuoka criteria and sensible duration of follow-up.
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schellhaas
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vitali
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Dane
authors.initials: D
authors.lastname: Wildner
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Rüdiger S
authors.initials: RS
authors.lastname: Görtz
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Pfeifer
authors.affiliation: Department of Internal Medicine II, Thuringia Clinic, Saalfeld, Germany.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Konturek
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, Friedrich-Alexander-Universität (FAU) University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Deike
authors.initials: D
authors.lastname: Strobel
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019160:Endosonography; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005791:Patient Care; D012017:Referral and Consultation