Bridging the intraductal papillary mucinous neoplasm risk stratification gap: A critical review of current and emerging biomarkers

Table 2 Real world clinical accuracy and key tradeoffs for different intraductal papillary mucinous neoplasm management guidelines

Guideline family	Sensitivity	Specificity	Key trade-offs	Ref.
Kyoto 2024 (IAP)	100%	20%	Pros: Almost no missed HGD/IC	[18]
			Cons: Very high overtreatment; many surgeries for low-grade IPMN; increases morbidity and costs
IAP/Fukuoka 2017 (≥ 1 WF or HRS)	90%-98%	16%-45%	Pros: Captures most HGD/IC; strong safety margin	[20]
			Cons: Over-calls risk; many unnecessary resections; psychological burden and repeated EUS/imaging for WF
European Evidence-Based 2018	94%-96%	24%	Pros: Good detection of high-risk disease; harmonized with European practice	[20]
			Cons: Low specificity → high surgical rates and overtreatment risk
AGA 2015	27%-62%	77%-91%	Pros: Few unnecessary surgeries; high specificity avoids morbidity and cost	[20]
			Cons: Substantial risk of missing HGD/IC (up to 45% may be missed in some cohorts); unsafe for high-risk IPMN
ACG 2018	Moderate-high (IAP-like)	Low-moderate	Pros: Good capture of advanced disease; cyst-type-specific guidance; clinically usable algorithms	[19]
			Cons: Still low specificity; many patients undergo EUS-FNA or resection unnecessarily
ACR 2017 (imaging-driven)	High (IAP-like)	Low-moderate	Pros: Easy to apply in imaging-first workflows; high sensitivity	[20]
			Cons: Overdetection leads to frequent EUS and surgeries; less nuanced than GI-society guidelines

IAP: International Association of Pancreatology; HGD/IC: High-grade dysplasia/invasive carcinoma; IPMN: Intraductal papillary mucinous neoplasm; HRS: High-risk stigmata; EUS: Endoscopic ultrasound; WF: Worrisome feature; AGA: American Gastroenterological Association; ACG: American College of Gastroenterology; FNA: Fine-needle aspiration; ACR: American College of Radiology; GI: Gastrointestinal.