Fukuoka-positive IPMNs<\/h3>\n\n\n\n
Fukuoka-positive IPMNs are those that have high-risk stigmata for malignancy. These include IPMNs:<\/p>\n\n\n\n
- In the pancreatic head that have led to obstructive icterus<\/li>
- With mural nodules ? 5 mm in size that take up contrast medium <\/li>
- With dilation of the main pancreatic duct to ? 10 mm (known as main duct IPMNs)<\/li><\/ul>\n\n\n\n<\/div>\n\n\n\n
IPMNs with \u201cworrisome features\u201d<\/h3>\n\n\n\n
IPMNs with Fukuoka \u201cworrisome features\u201d are those with:<\/p>\n\n\n\n
- Cystic lesions ? 3 cm in size<\/li>
- Cystic walls that are swollen or take up contrast medium<\/li>
- Dilation of the main pancreatic duct to 5\u20139 mm<\/li>
- Abrupt changes in the diameter of the pancreatic duct and distal atrophy<\/li>
- Evidence of lymph nodes<\/li>
- Increased serum CA 19-9 values<\/li>
- Cystic growth of at least 5 mm over 2 years<\/li>
- Clinical signs of pancreatitis<\/li><\/ul>\n\n\n\n<\/div>\n\n\n\n
Fukuoka-negative IPMNs<\/h3>\n\n\n\n
Fukuoka-negative IPMNs are those without high-risk stigmata and without the \u201cworrisome features\u201d described above.<\/p>\n\n\n\n
It is clear from these guideline criteria that the classification of IPMNs is now no longer carried out on the basis of their size and\/or main duct or branch duct involvement but must be done in a highly differentiated way. Criteria such as contrast-absorbing mural nodules < 5 mm or ? 5 mm in size can really only be reliably assessed with high-resolution contrast-enhanced harmonic endoscopic ultrasound (CH-EUS), or less precisely with magnetic resonance imaging (MRI) (Figs. 1\u20135).<\/p>\n\n\n\n
The guidelines also include recommendations regarding the therapeutic approach. In patients who are operable, Fukuoka-positive IPMNs should be treated surgically. In the presence of \u201cworrisome features\u201d and EUS evidence of mural nodules ? 5 mm, evidence of changes in the main duct, or the presence of malignancy-suspicious or even malignant cytology, surgical resection should also be aimed for. If none of that is the case, then depending on the size of the IPMN, check-ups using CT\/MRI or EUS should be carried out at specific intervals. Figure 6 provides an overview of the diagnostic and therapeutic approach in IPMNs on the basis of the revised Fukuoka Guidelines [3].<\/p>\n\n\n\n
An approach based on these guidelines has shown that the risk of overtreating \u201charmless\u201d IPMNs due to unjustified surgery, and at the same time the development of malignant tumors out of apparently \u201charmless\u201d IPMNs, is extremely low. A study including more than 1,100 patients with IPMNs showed that the rate of malignancy developing within 5 years in Fukuoka-negative IPMNs was less than 2%. In the presence of \u201cworrisome features,\u201d the carcinoma risk in unoperated IPMNs is approximately 4%, whereas in Fukuoka-positive patients, pancreatic carcinoma was demonstrated within 5 years in 49% [4].<\/p>\n\n\n\n
When patients with an IPMN are being monitored, attention must always be given to the fact that pancreatic malignancies may also occur more frequently outside of and independently of the cystic lesions [5]. Surveillance should therefore always include the entire pancreas.<\/p>\n\n\n\n
\n\n![\"\"](\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/Fukoka-Guidelines-01-1.jpg\")
Fig. 1 A small Fukuoka-negative branch duct IPMN in the tail of the pancreas<\/figcaption><\/figure><\/div>\n\n\n\n ![\"\"](\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/Fukoka-Guidelines-03-1.jpg\")
Fig. 3?An IPMN with an easily recognizable ductal connection to the main pancreatic duct in the head of the pancreas<\/figcaption><\/figure><\/div>\n<\/div>\n\n\n\n \n![\"\"](\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/Fukoka-Guidelines-02-1.jpg\")
Fig. 2?An IPMN with a mural nodule 3.8 mm in size<\/figcaption><\/figure><\/div>\n\n\n\n ![\"\"](\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/Fukoka-Guidelines-04.jpg\")
Fig. 4?An IPMN with Fukuoka \u201cworrisome features\u201d in the body of the pancreas (> 3 cm, with a large mural nodule and no contrast uptake on CH-EUS)<\/figcaption><\/figure><\/div>\n<\/div>\n<\/div>\n\n\n\n \n\n![\"\"](\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/Fukoka-Guidelines-05-1.jpg\")
Fig. 5?An IPMN with an IPMN-associated pancreatic carcinoma<\/figcaption><\/figure><\/div>\n<\/div>\n\n\n\n <\/div>\n<\/div>\n\n\n\n![\"\"](\"https:\/\/www.endoscopy-campus.com\/wp-content\/uploads\/Fukoka-Guidelines-06.jpg\")
Fig. 6?Diagnostic and therapeutic procedure for IPMNs in accordance with the revised Fukuoka Guidelines [3]<\/figcaption><\/figure><\/div>\n\n\n\n References<\/h3>\n\n\n\n
- Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. \u2018International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas\u2019. Pancreatology 2006; 6: 17\u201332.<\/li>
- Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. \u2018International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas\u2019, Pancreatology 2012; 12: 183\u201397.<\/li>
- Tanaka M, Fernandez-del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. \u2018Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas\u2019, Pancreatology 2017; 17 :738\u201353.<\/li>
- Mukewar S, de Pretis N, Aryal-Khanal A, Ahmed A, Sah R, Enders F, Larson JJ, et al. \u2018Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be intraductal papillary mucinous neoplasms\u2019, Gut 2017 Oct; 66(10): 1811\u201317.<\/li>
- Yamaguchi K, Kanemitsu S, Hatori T, Maguchi H, Shimizu Y, Tada M, et al.
\u2018Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN\u2019, Pancreas 2011; 40: 571\u201380. <\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"Increasing numbers of cystic tumors in the pancreas are being diagnosed. It is often difficult to precisely assign these highly varied tumors to a specific entity and to distinguish them from nonneoplastic cystic lesions in the pancreas (e.g., pseudocysts). One type of lesion that is receiving particular attention \u2014 not only due to its frequency \u2014 is intraductal papillary mucinous neoplasia (IPMN) in the pancreas.<\/p>\n","protected":false},"featured_media":0,"template":"","categories":[94,1798],"tags":[1659,1387,1372,1220,1349,1658,1384,927,271,1661,1469,1388,1660,1442,1662,1663,664,1386],"ec-magazin-ausgaben":[1531],"sponsoren-erwaehnung":[],"autor":[],"class_list":["post-4800","klassifikationen","type-klassifikationen","status-publish","hentry","category-classifications","category-pancreatobiliary-system-and-liver","tag-cystic","tag-intraduktalen","tag-ipmn","tag-lesion","tag-lesions","tag-neoplasia","tag-neoplasie","tag-pancreas-en","tag-pancreas","tag-pancreatectomy","tag-pancreatic-duct","tag-papillaeren","tag-papillary-mucinous-neoplasia","tag-pseudocyst","tag-sendai","tag-stigmata","tag-tumor","tag-zystische-tumoren","ec-magazin-ausgaben-ec-magazine-2019-01"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/klassifikationen\/4800","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/klassifikationen"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/klassifikationen"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=4800"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=4800"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=4800"},{"taxonomy":"ec-magazin-ausgaben","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-magazin-ausgaben?post=4800"},{"taxonomy":"sponsoren-erwaehnung","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/sponsoren-erwaehnung?post=4800"},{"taxonomy":"autor","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/autor?post=4800"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}