Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be...

Area of Science:

• Gastroenterology
• Oncology
• Medical Imaging

Background:

• Pancreatic cystic lesions (PCLs) presumed to be intraductal papillary mucinous neoplasms (IPMNs) require risk stratification.
• Fukuoka consensus guidelines classify PCLs into Fukuoka positive (FP) and Fukuoka negative (FN) categories, with FP further divided into high-risk (HR) and worrisome features (WFs).

Purpose of the Study:

• To retrospectively estimate the 5-year risk of pancreatic cancer (PC) in patients with PCLs classified as FN, WF, and HR based on Fukuoka guidelines.
• To evaluate the accuracy of Fukuoka guidelines in stratifying PC risk for PCL-IPMNs.

Main Methods:

• Retrospective review of cross-sectional imaging and clinical data from 2000 patients with PCLs at Mayo Clinic.
• Exclusion of inflammatory, non-IPMN, and non-follow-up cysts, resulting in a study cohort of 802 patients with FN cysts and 358 with FP cysts.
• Analysis of 5-year PC risk stratified by cyst category (FN, WF, HR) and specific high-risk features.

Main Results:

• Among FN cysts, the 5-year PC risk was low (2-3%) regardless of cyst size, remaining low (0-2%) even after excluding early events.
• Among FP cysts, HR cysts exhibited a significantly higher 5-year PC risk (49.7%) compared to WF cysts (4.1%).
• In HR cysts, obstructive jaundice, enhancing solid component, or main pancreatic duct >10 mm were associated with the highest 3-year PC risk (79.8%, 37.3%, 39.4% respectively).

Conclusions:

• Fukuoka guidelines accurately stratify PCL-IPMNs for pancreatic cancer risk.
• FN and WF cysts demonstrate a low 5-year PC risk after initial follow-up.
• Surveillance strategies for PCL-IPMNs should be tailored based on the risk stratification provided by the Fukuoka guidelines.