Diagnostic utility of biopsy specimens for autoimmune pancreatitis

• Published in: Journal of gastroenterology Vol. 44; no. 7; pp. 765 - 773
• Main Authors: Hirano, Kenji, Fukushima, Noriyoshi, Tada, Minoru, Isayama, Hiroyuki, Mizuno, Suguru, Yamamoto, Keisuke, Yashima, Yoko, Yagioka, Hiroshi, Sasaki, Takashi, Kogure, Hirofumi, Nakai, Yousuke, Sasahira, Naoki, Tsujino, Takeshi, Kawabe, Takao, Fukayama, Masashi, Omata, Masao
• Format: Journal Article
• Language: English
• Published: Japan Japan : Springer Japan 01.07.2009; Springer Japan; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Autoimmune Diseases - diagnosis; Autoimmune Diseases - pathology; Bile Ducts - pathology; Biliary Tract; Biopsy - methods; Biopsy, Needle; Cell Count; Colorectal Surgery; Duodenum - pathology; Female; Gastric Mucosa - pathology; Gastroenterology; Hepatology; Humans; Immunoglobulin G - analysis; Immunoglobulin G - blood; Liver - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article—Liver; Pancreas; Pancreatic Ducts - pathology; Pancreatitis - diagnosis; Pancreatitis - pathology; Plasma Cells - immunology; Plasma Cells - pathology; Prognosis; Surgical Oncology; IgG4; Biopsy; Autoimmune pancreatitis; Plasma cell
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-009-0052-8

Background and aims Infiltration of IgG4-positive plasma cells in the pancreas and other organs is characteristic of autoimmune pancreatitis (AIP). However, it is undetermined whether needle or forceps biopsy of pancreas or other organs is indeed useful for the diagnosis of AIP. We aimed to clarify this point. Methods Among 39 AIP patients, tissue sampling without laparotomy was performed in 27. Biopsy of pancreas, gastric mucosa, liver, bile duct, and duodenal papilla was performed in 15, 17, 11, 5 and 7, respectively. The obtained specimens were examined for IgG4-positive plasma cells. We also examined gastric mucosa of 18 patients with pancreatic cancer as controls. When the number of IgG4-positive plasma cells was more than 10 per high-power field, we regarded it as diagnostic. Results Diagnostic sensitivity in pancreas, gastric mucosa, liver, bile duct, and duodenal papilla was 47% (7/15), 47% (8/17), 36% (4/11), 0% (0/5), and 57% (4/7), respectively. Conclusions Sensitivity of IgG4 immunostaining was unsatisfactory when tissue sampling was performed by needle or forceps biopsy. Biopsy of gastric mucosa might be a good subsidiary diagnostic tool.