Received: 9 May 2017
Accepted: 18 September 2017
Validation of Sendai and Fukuoka consensus guidelines in
predicting malignancy in patients with preoperatively
diagnosed mucinous pancreatic cystic neoplasms
Wentao Zhou MD
Yadong Xu MD
Wenchuan Wu MD
Tiantao Kuang MD
Baobao Xin MD
Hongxu Zhu MD
Wenhui Lou MD PhD
Department of General Surgery, Zhong Shan
Hospital, Fudan University, Shanghai, China
Department of Pancreatic Surgery, Zhong
Shan Hospital, Fudan University, Shanghai,
Wenhui Lou, MD, PhD, Department of
Pancreatic Surgery, Zhong Shan Hospital,
Fudan University, No. 180, Fenglin Road,
Xuhui District, Shanghai 200032, China.
Dansong Wang, MD, Department of General
Surgery, Zhong Shan Hospital, Fudan
University, No. 180, Fenglin Road, Xuhui
District, Shanghai 200032, China.
National Natural Science Foundation of China,
Grant number: 81401923
Background and Objectives: The Sendai consensus guidelines (SCG) and Fukuoka
consensus guidelines (FCG) have been examined for their roles in predicting advanced
neoplasia (AN) in pancreatic cystic neoplasm (PCN) patients with mixed results. We aim
to evaluate the utilities of both guidelines in a Chinese cohort with preoperatively
diagnosed mucinous PCNs.
Methods: One hundred ninety-seven patients who underwent resections from 2008
to 2015 in Zhong Shan Hospital, Fudan University for suspected PCNs were
retrospectively reviewed. Receiver operating characteristic (ROC) curves were
calculated and compared to measure diagnostic value.
Results: Fifty-five patients were diagnosed with AN pathologically. The sensitivity,
specificity, positive predictive value, negative predictive value, and accuracy of the
SCG high-risk (SCG
) criteria were 87.3%, 28.2%, 32.0%, 85.1%, and 44.7%,
respectively, and for the FCG high-risk (FCG
) criteria, they were 40.0%, 95.8%,
78.6%, 80.5%, and 80.2%, respectively. ROC curve comparison analyses showed that
were superior to the SCG
(P = 0.02). The performance of the FCG
enhanced with CA19-9 incorporated (P = 0.004).
Conclusions: The FCG were superior to the SCG in this retrospective analysis, which
could be further improved by the incorporation of CA19-9. However, the practical
safety remains uncertain because of missed invasive carcinoma cases.
advanced neoplasia, Fukuoka consensus guidelines, mucinous pancreatic cystic neoplasm,
Sendai consensus guidelines
Abbreviations: AN, advanced neoplasia; AUC, area under the curve; BD-IPMN, branch-duct IPMN; CA19-9, carbohydrate antigen 19-9; CT, computed tomography; EUS, endoscopic
ultrasound; FCG, Fukuoka consensus guidelines; HGD, high-grade dysplasia; HR, high-risk; IQR, interquartile range; IPMN, intraductal papillary mucinous neoplasm; MCN, mucinous cystic
neoplasm; MD-IPMN, main-duct IPMN; MPD, main pancreatic duct; MRI, magnetic resonance imaging; MT-IPMN, mixed-type IPMN; NET, neuroendocrine tumor; NPV, negative predictive
value; PCN, pancreatic cystic neoplasm; PPV, positive predictive value; ROC, receive operating characteristic; SCA, serous cystadenoma; SCG, Sendai consensus guidelines; SPT, solid
pseudopapillary tumor; W, worrisome.
J Surg Oncol. 2018;117:409–416. wileyonlinelibrary.com/journal/jso © 2017 Wiley Periodicals, Inc.