Kyoto guidelines
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The Tanaka criteria (or, also referred as Fukuoka consensus guidelines) is, is a classification system for intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs).
The prior international consensus guidelines (2006) were referred to as the Sendai criteria. This later evolved into the Fukuoka consensus guidelines (2012).
Classification
- branch duct IPMN (BD-IPMN)
- main duct IPMN (MD-IPMN)
- higher frequency of malignancy
- dilatation of the main duct >5 mm without other cause for obstruction
- 5-9 mm: "worrisome feature"
- ≥10 mm: "high
risk-risk stigmata"
- mixed-type IPMN: appears like an advanced branch duct IPMN with main pancreatic duct dilatation (>5 mm)
- higher frequency of malignancy, similar to the main duct type
High risk-risk stigmata
- enhancing solid component
- main pancreatic duct ≥10 mm
- obstructive jaundice
Worrisome features
- cyst ≥3 cm
- thickened and enhancing cyst wall
- nonenhancing mural nodule
- main pancreatic duct 5-9 mm
- lymphadenopathy
Histological subclassification
- gastric type: the majority of BD-IPMNs
- intestinal type
- pancreaticobiliary type
- oncocytic type
Treatment and prognosis
- resection
- all main duct IPMNs
- all other IPMNs with high
risk-risk stigmata - all MCNs
-
endoscopic ultrasound (EUS)
- cysts with worrisome features
- all cysts ≥3 cm without worrisome features
- if inconclusive, then close surveillance with alternating MRI and EUS every 3-6 months
- strongly consider surgery in young patients
- optimal imaging surveillance strategies for BD-IPMNs <3 cm and without worrisome features is unclear, but the yearly incidence of transformation to pancreatic cancer is estimated at 0.4-1.1% per year
- largest cyst <1 cm: CT or MRI/MRCP in 2-3 years
- largest cyst 1-2 cm: CT or MRI/MRCP annually for 2 years, then lengthen interval if no change
- largest cyst 2-3 cm: EUS in 6 months, the lengthen interval alternating MRI with EUS as appropriate
- consider surgery in young patients
Cyst fluid analysis is optional in centera centre with expertise in EUS fine needle aspiration.
-<p>The <strong>Tanaka criteria</strong> (or <strong>Fukuoka consensus guidelines</strong>) is a classification system for <a href="/articles/intraductal-papillary-mucinous-neoplasm">intraductal papillary mucinous neoplasms (IPMNs)</a> and <a href="/articles/mucinous-cystic-neoplasms-of-the-pancreas">mucinous cystic neoplasms (MCNs)</a>.</p><p>The prior international consensus guidelines (2006) were referred to as the <em>Sendai criteria</em>. This later evolved into the <em>Fukuoka </em>consensus guidelines (2012).</p><h4>Classification</h4><ul>- +<p>The <strong>Tanaka criteria</strong>, also referred as <strong>Fukuoka consensus guidelines</strong>, is a classification system for <a href="/articles/intraductal-papillary-mucinous-neoplasm">intraductal papillary mucinous neoplasms (IPMNs)</a> and <a href="/articles/mucinous-cystic-neoplasms-of-the-pancreas">mucinous cystic neoplasms (MCNs)</a>.</p><p>The prior international consensus guidelines (2006) were referred to as the <em>Sendai criteria</em>. This later evolved into the <em>Fukuoka </em>consensus guidelines (2012).</p><h4>Classification</h4><ul>
-<li>≥10 mm: "high risk stigmata"</li>- +<li>≥10 mm: "high-risk stigmata"</li>
-<li>mixed-type IPMN: appears like an advanced branch duct IPMN with main pancreatic duct dilatation (>5 mm)<ul><li>higher frequency of malignancy, similar to main duct type</li></ul>- +<li>mixed-type IPMN: appears like an advanced branch duct IPMN with main pancreatic duct dilatation (>5 mm)<ul><li>higher frequency of malignancy, similar to the main duct type</li></ul>
-</ul><h5>High risk stigmata</h5><ul>- +</ul><h5>High-risk stigmata</h5><ul>
-<li>all other IPMNs with high risk stigmata</li>- +<li>all other IPMNs with high-risk stigmata</li>
-<li>endoscopic ultrasound (EUS)<ul>- +<li>
- +<a title="Endoscopic ultrasound" href="/articles/endoscopic-ultrasound">endoscopic ultrasound (EUS)</a><ul>
-</ul><p>Cyst fluid analysis is optional in center with expertise in EUS fine needle aspiration.</p>- +</ul><p>Cyst fluid analysis is optional in a centre with expertise in EUS fine needle aspiration.</p>
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