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28 March 2017 : Clinical Research  

Dynamics of Fukuoka Criteria and Patient Management in Pancreatic Intraductal Papillary Mucinous Neoplasms (IPMNs) During Follow-Up

Barbara Schellhaas1ABCDEF*, Francesco Vitali1B, Dane Wildner1B, Rüdiger S. Görtz1B, Lukas Pfeifer1B, Peter C. Konturek2E, Markus F. Neurath1E, Deike Strobel1ABDEF

DOI: 10.12659/MSM.900535

Med Sci Monit 2017; 23:1483-1492

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.

Keywords: Diagnostic Imaging, Endosonography, Pancreas, Pancreatic Cyst, Patient Care Management

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750