Tanaka criteria

The Tanaka criteria (or Fukuoka consensus guidelines) 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).


  • 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 stigmata"
  • mixed-type IPMN: appears like an advanced branch duct IPMN with main pancreatic duct dilatation (>5 mm)
    • higher frequency of malignancy, similar to main duct type
High 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 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 center with expertise in EUS fine needle aspiration.

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Article information

rID: 35423
Synonyms or Alternate Spellings:
  • Fukuoka consensus guidelines
  • International consensus guidelines for the management of IPMN and MCN of the pancreas (2012)
  • Sendai criteria

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