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Autoimmune Pancreatitis: Current Diagnostic Criteria Are Suboptimal.
MedLine Citation:
PMID:  21299615     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background and AIMS: The pre-operative diagnosis of autoimmune pancreatitis (AIP) is difficult given its similar clinical presentation to pancreatic cancer. The aims of the study are to describe our center's experience with AIP and apply the Japanese AIP diagnostic criteria to a cohort of patients with histologically proven AIP in order to assess their performance characteristics. METHODS: Prospective pathology database was queried for AIP patients who were evaluated and/or treated at Johns Hopkins Hospital from 2002-2009. AIP histology was defined by the presence of lymphoplasmacytic infiltration, periductal inflammation, fibrosis and periphlebitis. Imaging, clinical and biochemical data were analyzed. RESULTS: 30 patients had pancreatic resection with pathologic confirmation of AIP. Imaging revealed pancreatic mass (45%), focal prominence without mass lesion (24%), diffuse enlargement (17%), and normal pancreas (14%). Twenty-four patients underwent an ERCP and/or MRCP, and 4/24 (17%) had pancreatic ductal narrowing or irregularity. Extra panreaticobiliary organ involvement was found in 6% (n = 2) of patients. Biliary strictures were present in 87% of the patients. Of 16 patients who underwent preoperative tissue biopsy, 10 had non-diagnostic pathology, 5 had cellular atypia, and 1 had AIP. Serum IgG4 levels were elevated in 12/29 (41%) of patients. Three (10%) patients had evidence of extra-pancreatic manifestations of AIP. When applying the Japanese criteria to the 27 patients who had serum IgG4 measurement, preoperative biopsy and cross-sectional abdominal imaging, only 44% of the patients would have been diagnosed accurately. CONCLUSIONS: When applied to a highly selected single center referral population in the United States, current Japanese guidelines for the diagnosis of autoimmune pancreatitis have suboptimal sensitivity.
Authors:
Samuel A Giday; Mouen A Khashab; Jonathan M Buscaglia; Devi Mukkai Krishnamurty; Terina Chen; Anthony N Kalloo; Marcia I Canto; Patrick I Okolo; Ralph H Hruban; Sanjay B Jagannath
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-8
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  -     ISSN:  1440-1746     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
Affiliation:
Department of Medicine and Division of Gastroenterology and Hepatology and Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
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