Fukuoka Guidelines for IPMN Management
The Fukuoka guidelines provide an evidence-based approach to managing pancreatic IPMNs. This page summarizes the key components of these guidelines.
Types of IPMN
-
Main Duct IPMN
Involves the main pancreatic duct. Higher risk of malignancy (approximately 40-60%).
-
Branch Duct IPMN
Involves only the branch ducts of the pancreas. Lower risk of malignancy (approximately 15-25%).
-
Mixed IPMN
Involves both the main duct and branch ducts. Risk profile similar to main duct IPMN.
High-Risk Stigmata
The presence of any of these features is an indication for surgical resection (if the patient is an appropriate surgical candidate):
- Obstructive jaundice in a patient with a cystic lesion of the head of the pancreas
- Enhancing solid component/mural nodule ≥ 5mm
- Main pancreatic duct (MPD) size ≥ 10mm
High-risk stigmata generally warrant referral to HPB surgeon for consideration of surgical resection.
Worrisome Features
These features suggest increased risk but do not necessarily warrant immediate resection:
- Cyst size ≥ 3cm
- Thickened/enhancing cyst walls
- Main pancreatic duct (MPD) size 5-9mm
- Non-enhancing mural nodule
- Abrupt change in caliber of pancreatic duct with distal pancreatic atrophy
- Lymphadenopathy
- Elevated serum CA 19-9
- Cyst growth rate ≥ 5mm/2 years
- New-onset diabetes mellitus
- History of pancreatitis
Worrisome features suggest the need for further evaluation with EUS or closer surveillance.
Surveillance Recommendations
Branch Duct IPMN with no Worrisome Features
| Cyst Size | Surveillance Interval | Imaging Modality |
|---|---|---|
| < 1cm | Every 2-3 years | MRI/MRCP or CT |
| 1-2cm | Every 1-2 years | MRI/MRCP or CT |
| 2-3cm | Every 6-12 months | MRI/MRCP preferred |
| > 3cm | Every 3-6 months | MRI/MRCP, consider EUS |
Consider stopping surveillance after 5 years if no significant changes, depending on patient age and comorbidities.