Overview and comparison of guidelines for management of pancreatic cystic neoplasms

Table 3 Comparison of performance between pancreatic cyst guidelines

Studies	Comparisons	Outcome	Result	Performance
Sighinolfi et al[21], 2017	Fukouka, AGA, and Sendai Criteria1	Pancreatic Cyst with invasive cancer	AGA ROC 0.76, Fukouka ROC 0.78, Sendai ROC 0.65 (P < 0.001)	AGA and Fukuoka guidelines with higher diagnostic accuracy for neoplastic cysts compared to Sendai
Xu et al[20], 2017	AGA, Fukouka, and American College of Radiology1	Advanced neoplasia (HGD or cancer) in resected pancreatic cysts	(Sen, Spec, PPV, NPV) AGA; 7.3%, 88.2%, 10%, and 84.1% Fukouka: 73.2%, 45.6%, 19.5%, 90.4% ACR: 53.7%, 61%, 19.8%, and 88%	AGA with higher specificity, but lower sensitivity than Fukuoka and ACR
Ma et al[22], 2016	AGA and Fukouka2	Advanced neoplasia (HGD or cancer) in resected pancreatic cysts	Fukouka: 28.2%, 95.8%, 74.1%, 75.9% AGA: 35.2.%, 94%, 71.4%, 77.5%	No significant difference between the two guidelines
Singhi et al, 2016	AGA	Advanced neoplasia (HGD or cancer)	AGA: 62%, 79%, 57%, 82%	Low accuracy of AGA guidelines and continued surveillance of benign lesions (i.e., SCAs)
Lekkerkerker et al[23], 2017	Fukuoka, AGA, European Guidelines	Advanced neoplasia (in patients with suspected IPMN)	Accuracy Fukuoka: 54% AGA: 59% European: 53%	AGA guidelines would have rec’d against surgery in most patients with benign lesions and would have missed significantly more HGD/CA

¹These studies have considered high risk or worrisome features as sufficient for indication for resection (for example a cyst size > 3 cm would have qualified for an indication for surgery.

²In these studies the presence of high risks stigmata or worrisome features with positive EUS/FNA were required. EUS: Endoscopic ultrasonography; ACG: American College of Gastroenterology; AGA: American Gastroenterological Association.