Pancreatic Cysts (Fukuoka / ACR)
IAP / ACR · Fukuoka 2017 · Updated Fukuoka 2017 (Kyoto 2024 in adoption)
IPMN and MCN surveillance. Worrisome features and high-risk stigmata drive endoscopic ultrasound vs surgical resection.
Enhancing mural nodule ≥5 mm, MPD ≥10 mm, or obstructive jaundice → surgical consultation.
Incidentally detected pancreatic cystic lesions · Suspected IPMN or MCN on CT / MRI / MRCP
Pseudocysts (post-pancreatitis) — clinical management · Solid pseudopapillary neoplasms and cystic neuroendocrine tumors
CT / MRI
International consensus — expert panel
Stratify by worrisome features (WF) and high-risk stigmata (HRS). HRS → surgical consultation. WF → EUS ± FNA. Neither → size-based surveillance.
Overview
IPMN and MCN surveillance. Worrisome features and high-risk stigmata drive endoscopic ultrasound vs surgical resection.
Quick reference
| Feature | Threshold |
|---|---|
| Enhancing mural nodule | ≥ 5 mm |
| Main pancreatic duct | ≥ 10 mm |
| Obstructive jaundice | In a patient with a cystic lesion of the head |
| Feature | Threshold |
|---|---|
| Cyst size | ≥ 3 cm |
| Enhancing mural nodule | < 5 mm |
| Thickened / enhancing walls | — |
| Main duct | 5–9 mm |
| Abrupt change in caliber with distal atrophy | — |
| Lymphadenopathy · elevated CA 19-9 · growth ≥ 5 mm/2 y | — |
Decision algorithm
Surveillance vs surgery for the incidental pancreatic cyst.
References
- Tanaka M et al. Pancreatology 2017 (Fukuoka)
Tanaka M, Fernández-del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17(5):738-753.