Fukuoka Guidelines (Branch-Duct IPMN)
Sorts a branch-duct intraductal papillary mucinous neoplasm into the two tiers of the international consensus Fukuoka guidelines.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Cyst 3 cm or larger
- Yes
- Thickened or enhancing cyst walls
- Yes
Result: 2 worrisome features and no high-risk stigma, so endoscopic ultrasound
The tool opens with these values already filled in. Replace them with your own.
What the result means
- High-risk stigmata
- Obstructive jaundice attributable to a cystic lesion of the pancreatic head, an enhancing mural nodule 5 mm or larger, or a main pancreatic duct 10 mm or wider.
- What they mean
- Any one is a reason to consider resection in a patient fit for it.
- Worrisome features
- Pancreatitis, a cyst 3 cm or larger, an enhancing nodule under 5 mm, thickened or enhancing cyst walls, or a main pancreatic duct of 5 to 9 mm.
- Worrisome, continued
- An abrupt change in duct caliber with distal atrophy, lymphadenopathy, a raised serum CA 19-9, or cyst growth of 5 mm or more over two years.
- What they mean
- Endoscopic ultrasound. Not resection. The two tiers are routinely conflated, and the middle tier buys information rather than an operation.
- Size
- A cyst of 3 cm or more is a worrisome feature, not a high-risk stigma. The 2017 revision moved it down from where the 2012 version had it.
- The same measurement, two tiers
- A main duct of 10 mm or more is high-risk and 5 to 9 mm is worrisome; a nodule of 5 mm or more is high-risk and under 5 mm is worrisome. It must be enhancing in both.
What you enter
- Obstructive jaundice attributable to a cystic lesion of the pancreatic head (high-risk stigma)
- Enhancing mural nodule 5 mm or larger (high-risk stigma)
- Main pancreatic duct 10 mm or wider (high-risk stigma)
- Pancreatitis (worrisome feature)
- Cyst 3 cm or larger (worrisome feature)
- Enhancing mural nodule under 5 mm (worrisome feature)
- Thickened or enhancing cyst walls (worrisome feature)
- Main pancreatic duct 5 to 9 mm (worrisome feature)
The other 4 fields
- Abrupt change in duct caliber with distal pancreatic atrophy (worrisome feature)
- Lymphadenopathy (worrisome feature)
- Raised serum CA 19-9 (worrisome feature)
- Cyst growth of 5 mm or more over two years (worrisome feature)
How this is calculated
Tanaka M, Fernandez-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. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.