Laparoscopic and Percutaneous Core Needle Biopsy Plays a Central Role for the Diagnosis of Autoimmune Pancreatitis in a Single-Center Study From Denmark

Pancreas. 2015 Aug;44(6):845-58. doi: 10.1097/MPA.0000000000000312.

Abstract

Objectives: The aims of this study were to describe the diagnosis of autoimmune pancreatitis (AIP) in Denmark and to test the usefulness of the International Consensus Diagnostic Criteria (ICDC) on a geographically well-defined cohort.

Methods: All patients diagnosed with AIP at Odense University Hospital from 2007 to 2013 were included (n = 30; mean follow-up, 26.2 months). Data from laparoscopic or percutaneous ultrasound-guided core needle biopsy (CNB), resection specimens, endoscopic ultrasound (EUS), EUS-guided CNB, computed tomography, serum immunoglobulin G4 (IgG4), and pancreatography were retrospectively analyzed according to ICDC.

Results: Twenty patients were diagnosed with type 1, 8 with type 2, and 2 with not otherwise specified AIP. Twenty-eight patients (93%) could correctly be classified when ICDC were retrospectively applied. Serum IgG4 was elevated in 44% of type 1 and 0% of type 2. Other organ involvement was observed in 40% of type 1 and 13% of type 2, but inflammatory bowel disease only in type 2 (P = 0.001). One patient had IgG4-related chronic perisplenitis as a hitherto undescribed manifestation of IgG4-related disease. Nineteen (91%) of 21 biopsied patients had diagnostic CNB features of AIP. Computed tomography, EUS, and pancreatography showed features highly suggestive or supportive of AIP in 68%, 72%, and 71%, respectively.

Conclusions: Laparoscopic or percutaneous ultrasound-guided CNB had the highest sensitivity for AIP. The ICDC could retrospectively correctly diagnose 93% of the patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Autoimmune Diseases / blood
  • Autoimmune Diseases / diagnostic imaging
  • Autoimmune Diseases / epidemiology
  • Autoimmune Diseases / pathology*
  • Autoimmune Diseases / therapy
  • Biomarkers / blood
  • Biopsy, Large-Core Needle / methods*
  • Denmark / epidemiology
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration*
  • Female
  • Hospitals, University
  • Humans
  • Immunoglobulin G / blood
  • Immunosuppressive Agents / therapeutic use
  • Laparoscopy*
  • Male
  • Middle Aged
  • Pancreatitis / blood
  • Pancreatitis / diagnostic imaging
  • Pancreatitis / epidemiology
  • Pancreatitis / pathology*
  • Pancreatitis / therapy
  • Predictive Value of Tests
  • Recurrence
  • Reproducibility of Results
  • Retrospective Studies
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Biomarkers
  • Immunoglobulin G
  • Immunosuppressive Agents