Are the Sendai and Fukuoka Consensus Guidelines for Cystic Mucinous Neoplasms of the Pancreas Useful in the Initial Triage of all Suspected Pancreatic Cystic Neoplasms? A Single-Institution Experience with 317 Surgically-Treated Patients

• Published in: Annals of surgical oncology Vol. 21; no. 6; pp. 1919 - 1926
• Main Authors: Goh, Brian K. P., Tan, Damien M. Y., Thng, Choon-Hua, Lee, Ser-Yee, Low, Albert S. C., Chan, Chung-Yip, Wong, Jen-San, Lee, Victor T. W., Cheow, Peng-Chung, Chow, Pierce K. H., Chung, Alexander Y. F., Wong, Wai-Keong, Ooi, London L. P. J.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-06-2014; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; CA-19-9 Antigen - blood; Carcinoembryonic Antigen - blood; Dilatation, Pathologic - pathology; Endosonography; Female; Humans; Japan; Jaundice, Obstructive - etiology; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms, Cystic, Mucinous, and Serous - classification; Neoplasms, Cystic, Mucinous, and Serous - diagnostic imaging; Neoplasms, Cystic, Mucinous, and Serous - pathology; Oncology; Pancreatic Ducts - diagnostic imaging; Pancreatic Ducts - pathology; Pancreatic Neoplasms - classification; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Tumors; Practice Guidelines as Topic; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Surgery; Surgical Oncology; Tomography, X-Ray Computed; Triage; Young Adult; Positive Predictive Value; Main Pancreatic Duct; Obstructive Jaundice; Negative Predictive Value; Solid Component
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-3501-4

Background
The Sendai Consensus Guidelines (SCG) were formulated in 2006 and updated in Fukuoka in 2012 (FCG) to guide management of cystic mucinous neoplasms of the pancreas. This study aims to evaluate the clinical utility of the SCG and FCG in the initial triage of all suspected pancreatic cystic neoplasms.
Study Design
Overall, 317 surgically-treated patients with a suspected pancreatic cystic neoplasm were classified according to the SCG as high risk (HR
SCG
) and low risk (LR
SCG
), and according to the FCG as high risk (HR
FCG
), worrisome (W
FCG
), and low risk (LR
FCG
). Cystic lesions of the pancreas (CLP) were classified as potentially malignant/malignant or benign according to the final pathology.
Results
The presence of symptoms, proximal lesions with obstructive jaundice, elevated serum carcinoembryonic antigen/carbohydrate antigen 19-9 (CEA/CA 19-9), size ≥3 cm, presence of solid component, main pancreatic duct dilatation, thickened enhancing walls, and change in ductal caliber with distal atrophy were predictive of a potentially malignant/malignant CLP on univariate analyses. The positive predictive value (PPV) and negative predictive value (NPV) of HR
SCG
and HR
ICG2012
for a potentially malignant/malignant lesion was 67 and 88 %, and 88 and 92.5 %, respectively. There were no malignant lesions in both LR groups but some potentially malignant lesions such as cystic pancreatic neuroendocrine neoplasms with uncertain behavior were classified as LR.
Conclusion
The updated FCG was superior to the SCG for the initial triage of all suspected pancreatic cystic neoplasms. CLP in the LR
FCG
group can be safely managed conservatively, and those in the HR
FCG
group should undergo resection.