Serum IgG4 Elevation in Pancreatic Cancer

Ngwa, Taiwo; Law, Ryan; Hart, Phil A.; Smyrk, Thomas C.; Chari, Suresh T.

doi:10.1097/mpa.0000000000000297

Cited by 39 publications

(20 citation statements)

References 28 publications

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“…[ 10 , 12 , 25 , 26 ] In a recent study from the United States, elevated serum IgG4 was found in 66% of AIP and 10% of PC. [ 14 ] When using a cut-off of 1.4 g/L, the sensitivity and specificity of serum IgG4 in differentiating AIP from PC were 45% and 88% in our study. In a recent meta-analysis, the respective values were 73% and 93%.…”

Section: Discussionmentioning

confidence: 60%

“…As expected and in accordance with earlier studies, we found a significant difference regarding mean serum IgG4 concentrations between AIP, PC, and ACP patients. [ 12 , 14 , 17 , 23 – 28 ] 45% of AIP, 58% of type 1 AIP, and 12% of PC patients had serum IgG4 values above the cut-off of 1.4 g/L. In comparison, Chang et al [ 12 ] reported IgG4 levels above this cut-off in 64.8% of AIP and 20% of PC patients.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

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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“…As is proposed in ICDC, IgG4 elevation is a high-specific serum marker for AIP [ 49 , 50 ]. However, Ngwa et al [ 91 ] reported that 10.1% of 548 patients with pancreatic cancer have elevated serum IgG4, which may be confusing when serum IgG4 is used to differentiate pancreatic cancer and AIP. Serum CA19-9 was stated to be useful for distinguishing AIP from pancreatic cancer [ 92 ], while CA19-9 can also be elevated in other pancreatic diseases or in other pathological states [ 93 ].…”

Section: Differential Diagnosis and The Strategy For Distinguishinmentioning

confidence: 99%

From Pathogenesis, Clinical Manifestation, and Diagnosis to Treatment: An Overview on Autoimmune Pancreatitis

Cai

Sheng

2017

Gastroenterology Research and Practice

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Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis which is autoimmune mediated. The international consensus diagnostic criteria (ICDC) 2011 proposed two types of AIP: type I is associated with histological pattern of lymphoplasmacytic sclerosing pancreatitis (LPSP), characterized by serum IgG4 elevation, whereas type 2 is named idiopathic duct-centric pancreatitis (IDCP), with granulocytic epithelial lesion (GEL) and immunoglobulin G4 (IgG4) negative. The pathogenic mechanism is unclear now; based on genetic factors, disease specific or related antigens, innate and adaptive immunity may be involved. The most common clinical manifestations of AIP are obstructive jaundice and upper abdominal pain. The diagnosis can be made by a combination of parenchymal and ductal imaging, serum IgG4 concentrations, pancreatic histology, extrapancreatic disease, and glucocorticoid responsiveness according to ICDC 2011. Because of the clinical and imaging similarities with pancreatic cancer, general work-up should be done carefully to exclude pancreatic malignant tumor before empirical trial of glucocorticoid treatment. Glucocorticoid is the most common drug for AIP to induce remission, while there still exists controversy on steroid maintenance and treatment for relapse. Further studies should be done to identify more specific serum biomarkers for AIP, the pathogenic mechanisms, and the treatment for relapse.

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“…However, test of serum IgG4 is rarely performed unless assuming AIP, which depending on the physicians’ clinical experience and their familiarity of the disease. Moreover, 10% of patients with pancreatic carcinoma had elevated serum IgG4 (>140 mg/dL), and in 1–2.4% it was elevated to twice the upper limit of normal, which makes IgG4 insufficient to be the golden diagnostic standard in the setting of obstructive jaundice/pancreatic mass [13, 16, 17]. Considering the limitation of IgG4 test, obtaining new evidence from routinely performed test results can certainly be helpful for primary diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Serological characteristics of autoimmune pancreatitis and its differential diagnosis from pancreatic cancer by using a combination of carbohydrate antigen 19-9, globulin, eosinophils and hemoglobin

Yan

Chen

et al. 2017

PLoS ONE

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Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which may be misdiagnosed as pancreatic carcinoma. This study aims to verify new biomarkers for AIP and propose a serological pattern to differentiate AIP from pancreatic adenocarcinoma with routinely performed tests. In this study, data of serum samples were collected and compared between 25 patients with AIP and 100 patients with pancreatic carcinoma. Receiver operating characteristic analysis and logistic regression was performed to evaluate the diagnostic effect of serum parameters in differentiating AIP from pancreatic carcinoma alone or in combination. Among several serum markers observed in the two groups, carbohydrate antigen 19–9 (Ca19-9), globulin, eosinophils and hemoglobin were selected as the independent markers. Serum levels of Globulin, Eosinophil percentage in AIP group were significantly higher than in pancreatic cancer group (P<0.05), while hemoglobin and tumor marker CA19-9 levels were lower (P <0.05). The combination of these markers identified patients with AIP with 92% sensitivity and 79% specificity, which indicated relatively high diagnostic value. Elevated serum eosinophils, globulin, together with decreased hemoglobin level can be used as a preoperative indicator for AIP and can help to initiate diagnosis of AIP in time.

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Serum IgG4 Elevation in Pancreatic Cancer

Abstract: Mild elevations in sIgG4 cannot distinguish AIP from PaC. Elevations more than 2 times upper limit of normal appear more commonly in AIP. Serum IgG4 elevation has no prognostic significance in PaC. We could not identify a relationship between AIP and PaC.

Cited by 39 publications

References 28 publications

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

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

From Pathogenesis, Clinical Manifestation, and Diagnosis to Treatment: An Overview on Autoimmune Pancreatitis

Serological characteristics of autoimmune pancreatitis and its differential diagnosis from pancreatic cancer by using a combination of carbohydrate antigen 19-9, globulin, eosinophils and hemoglobin

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