Microscopic findings in EUS‐guided fine needle (SharkCore) biopsies with type 1 and type 2 autoimmune pancreatitis

Detlefsen, Sönke; Jøergensen, Maiken Thyregod; Mortensen, Michael Bau

doi:10.1111/pin.12563

Cited by 34 publications

(21 citation statements)

References 20 publications

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“…Therefore, we could speculate that EUS-FNA/B is essential in excluding pancreatic cancer, especially in the focal form of AIP, but may not be necessary for a diagnosis of AIP in all patients, though this might result in misclassification of the disease regarding the specific subtype, as previously reported. 19,28 Recent advances in EUS needle technology, with needles specifically designed for EUS-FNB, 29,30 could improve the histology procurement, and should be evaluated in future studies. Furthermore, we need specific training of pathologists to establish the diagnosis of AIP effectively.…”

Section: Discussionmentioning

confidence: 99%

Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency

et al. 2020

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Background Autoimmune pancreatitis (AIP) is a rare, and relatively new, form of chronic pancreatitis. The management of AIP can vary considerably among different centres in daily clinical practice. Objectives The aim of this study is to present a picture of epidemiological, clinical characteristics, outcomes, and the real-life practice in terms of management in several academic and non-academic centres in Italy. Methods Data on the clinical presentation, diagnostic work-up, treatments, frequency of relapses, and long-term outcomes were retrospectively collected in a cohort of AIP patients diagnosed at 14 centres in Italy. Results One hundred and six patients were classified as type 1 AIP, 48 as type 2 AIP, and 19 as not otherwise specified. Epidemiological, clinical, radiological, and serological characteristics, and relapses were similar to those previously reported for different types of AIP. Endoscopic cytohistology was available in 46.2% of cases, and diagnostic for AIP in only 35.2%. Steroid trial to aid diagnosis was administered in 43.3% cases, and effective in 93.3%. Steroid therapy was used in 70.5% of cases, and effective in 92.6% of patients. Maintenance therapy with low dose of steroid (MST) was prescribed in 25.4% of cases at a mean dose of 5 (±1.4) mg/die, and median time of MST was 60 days. Immunosuppressive drugs were rarely used (10.9%), and rituximab in 1.7%. Faecal elastase-1 was evaluated in only 31.2% of patients, and was pathological in 59.2%. Conclusions In this cohort of AIP patients, diagnosis and classification for subtype was frequently possible, confirming the different characteristics of AIP1 and AIP2 previously reported. Nevertheless, we observed a low use of histology and steroid trial for a diagnosis of AIP. Steroid treatment was the most used therapy in our cohort. Immunosuppressants and rituximab were rarely used. The evaluation of exocrine pancreatic insufficiency is underemployed considering its high prevalence.

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Section: Discussionmentioning

confidence: 99%

Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency

et al. 2020

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“…However, with the development of needles for tissue acquisition, specimens that favorably compare with core biopsies in size can be obtained under EUS guidance (EUSguided fine needle biopsy, EUS-FNB), [9][10][11][12][13] which enables the biopsy diagnosis of AIP as a feasible method. [14][15][16] We created the guidance described below to standardize the biopsy diagnosis of AIP and improve its accuracy. To maintain the diagnostic integrity, this guidance is based on the AIP clinical diagnostic criteria 2018, 2,3 and AIP in the following statements indicates type 1 AIP unless otherwise noted.…”

Section: Introductionmentioning

confidence: 99%

Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

Notohara

Kamisawa

Fukushima

et al. 2020

Pathology International

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The biopsy‐based diagnosis of autoimmune pancreatitis (AIP) is difficult but is becoming imperative for pathologists due to the increased amount of endoscopic ultrasound‐guided biopsy tissue. To cope with this challenge, we propose guidance for the biopsy diagnosis of type 1 AIP. This guidance is for pathologists and comprises three main parts. The first part includes basic issues on tissue acquisition, staining, and final diagnosis, and is intended for gastroenterologists as well. The second part is a practical guide for diagnosing type 1 AIP based on the AIP clinical diagnostic criteria 2018. Inconsistent histological findings, tips for evaluating IgG4 immunostaining and key histological features including the ductal lesion and others are explained. Storiform fibrosis and obliterative phlebitis are diagnostic hallmarks but are sometimes equivocal. Storiform fibrosis is defined as spindle‐shaped cells, inflammatory cells and fine collagen fibers forming a flowing arrangement. Obliterative phlebitis is defined as fibrous venous obliteration with inflammatory cells. Examples of each are provided. The third part describes the differentiation of AIP from pancreatic ductal adenocarcinoma (PDAC), focusing on histological features of acinar‐ductal metaplasia in AIP, which is an important mimicker of PDAC. This guidance will help standardize pathology reports of pancreatic biopsies for diagnosing type 1 AIP.

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“…A pancreatic endoscopic ultrasound-guided fine-needle biopsy or a percutaneous core needle biopsy (CNB), an invasive procedure not without risk of complications, is often required for the diagnosis of AIP, especially when type 2 is considered. [ 7 , 8 ] van Heerde et al [ 9 ] found benign conditions in approximately 8% of patients who had a pancreaticoduodenectomy performed because of suspicion of PC, and around one-third of these had AIP. Therefore, it is relevant to explore new methods for diagnosing AIP and differentiating it from PC preoperatively, particularly in geographical areas such as France or Denmark, with a relatively high proportion of the IgG4-negative subtype of AIP (type 2) and/or a relatively low sensitivity of serum IgG4 in type 1 AIP.…”

Section: Introductionmentioning

confidence: 99%

Value of anti-plasminogen binding peptide, anti-carbonic anhydrase II, immunoglobulin G4, and other serological markers for the differentiation of autoimmune pancreatitis and pancreatic cancer

et al. 2018

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The diagnosis of autoimmune pancreatitis (AIP) and its differential diagnosis from pancreatic cancer (PC) can be challenging. In this retrospective study, we aimed to evaluate the value of anti-plasminogen binding peptide (a-PBP), immunoglobulin G4 (IgG4), and anti-carbonic anhydrase-II (a-CA-II), together with other serological markers whose value is not fully elucidated.The serum levels of a-PBP, IgG4, IgG, anti-nuclear antibodies (ANA), anti-lactoferrin (a-LF), a-CA-II, and rheumatoid factor (RF) were evaluated in patients with AIP (n = 29), PC (n = 17), pancreatic neuroendocrine neoplasm (P-NEN, n = 12), and alcoholic chronic pancreatitis (ACP, n = 41). ANCA were measured in the AIP patients.There was no statistically significant difference in mean a-PBP values in AIP compared with PC. A ROC curve showed that, when using a cut-off of 38.3 U, low values of a-PBP had a sensitivity and specificity of 45% and 71% for differentiating AIP from PC. The sensitivity and specificity of IgG4 (cut-off 1.4 g/L) for differentiating AIP from PC was 45% and 88%, but rose to 52% and 88% when using a cut-off of 1.09 g/L. When using this cut-off, the sensitivity and specificity for differentiating type 1 AIP from PC was 68% and 88%. None of the other markers were significantly changed in AIP versus PC. For differentiation of type 1 and type 2 AIP, the only significant differences were IgG4 in type 1 AIP (P < .01), with a sensitivity of 68% and a specificity of 80%, and c-ANCA elevations found in some type 2 AIP patients (P < .05).The only serological marker for which we found a statistically significant difference in mean values between AIP and PC was IgG4. However, the value of IgG4 for the distinction of AIP from PC was limited, probably in part due to the relatively high number of type 2 AIP patients in our study. In accord with recent publications, our data do not support a role of increased serum a-PBP for the diagnosis of AIP.

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Microscopic findings in EUS‐guided fine needle (SharkCore) biopsies with type 1 and type 2 autoimmune pancreatitis

Cited by 34 publications

References 20 publications

Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency

Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency

Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

Value of anti-plasminogen binding peptide, anti-carbonic anhydrase II, immunoglobulin G4, and other serological markers for the differentiation of autoimmune pancreatitis and pancreatic cancer

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