European Vs. Fukuoka Guidelines Preoperative Evaluations in Intraductal Papillary Mucinous Neoplasms

Abstract

Introduction: Adequate management of intraductal papillary mucinous neoplasm (IPMN) encompasses clinical, radiological, and histopathological findings. Several international guidelindes have been proposed and accepted for the IPMN management. The study aimed to evaluate and compare the diagnostic accuracy of 2017 International, Fukuoka and 2018 European evidence based guidelines in identifying malignant IPMN. Methods: The study analyzed 68 consecutive resected patients and 14 unresected patients diagnosed with IPMN at the Clinical Center of Serbia. Absolute/relative indications and high-risk stigmata/worrisome features of risk associated with carcinoma described in both guidelines were retrospectively analyzed together with the sensitivity, specificity, positive (PPV) and negative predictive values (NPV). Results: Based on European guidelines, the preoperative prediction of malignancy had high sensitivity for at least one absolute or relative indication for resection. Although comparable, European guidelines had higher sensitivity, but lower PPV and specificity in relations to Fukuoka guidelines. Unresectable patients are continued to be closely monitored in the absence of any absolute indications. Conclusion: Selection of patients, candidates for resection must be adequately done utilizing a multidisciplinary approach considering at the same time both the risks of surgery and malignancy.