ORIGINAL ARTICLE
A Comparative Study of Diagnostic Scoring Systems for Autoimmune Pancreatitis Marianne J. van Heerde, MD,* Jorie Buijs, MD,* Erik A. Rauws, MD, PhD,Þ Lucas J. Maillette de Buy Wenniger, MD,Þ Bettina E. Hansen, PhD,* Katharina Biermann, MD, PhD,þ Joanne Verheij, MD, PhD,§ Frank P. Vleggaar, MD, PhD,|| Menno A. Brink, MD, PhD,¶ Ulrich H. W. Beuers, MD, PhD,Þ Ernst J. Kuipers, MD, PhD,* Henk R. van Buuren, MD, PhD,* and Marco J. Bruno, MD, PhD* Objective: Several diagnostic scoring systems for autoimmune pancreatitis (AIP) have been proposed including the Asian, HISORt (Histology, Imaging, Serology, Other organ involvement and Response to therapy), and International Consensus Diagnostic Criteria (ICDC), which have been compared by a few studies. We evaluated the diagnostic performance of these criteria in patients diagnosed with AIP between May 1992 and August 2011. Methods: Scoring systems were applied retrospectively using data obtained in the initial evaluation period, before pancreatic resection was performed. Results: One hundred fourteen cases with AIP were included. Eightytwo percent met the diagnostic criteria for AIP according to either the Asian, HISORt, or ICDC criteria. Only 33% met the Asian criteria, probably mainly related to a low rate of diagnostic pancreatography. In 18%, all scoring systems failed to confirm the diagnosis, even though these patients were considered to have a firm diagnosis of AIP. Conclusions: In this cohort of AIP patients, the 3 major diagnostic scoring systems for AIP proved to be complementary rather than overlapping. Our data indicate that one-fifth of our AIP patients do not meet any of these scoring systems. The ICDC, Asian, and HISORt criteria should be considered as useful clinical tools but not as criterion standard for the diagnosis. Key Words: autoimmune pancreatitis, IgG4, IgG4-related disease, diagnostic criteria (Pancreas 2014;43: 559Y564)
A
utoimmune pancreatitis (AIP) represents the pancreatic manifestation of immunoglobulin G4 (IgG4)Yrelated sclerosing disease that may affect not only the pancreas but also other organs including the extrapancreatic biliary tract, salivary glands, retroperitoneal tissues, and kidneys.1 Because AIP often
From the *Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam; †Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam; ‡Department of Pathology, Erasmus University Medical Center; and §Department of Pathology, Academic Medical Center, Amsterdam; ||Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht; and ¶Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands. Received for publication February 10, 2013; accepted October 28, 2013. M.J.v.H. and J.B. contributed equally to this study. Reprints: Marianne J. van Heerde, MD, Gravin van Stauffenstraat 15, 4854 EL Bavel, the Netherlands (e
A Comparative Study of Diagnostic Scoring Systems for Autoimmune Pancreatitis Marianne J. van Heerde, MD,* Jorie Buijs, MD,* Erik A. Rauws, MD, PhD,Þ Lucas J. Maillette de Buy Wenniger, MD,Þ Bettina E. Hansen, PhD,* Katharina Biermann, MD, PhD,þ Joanne Verheij, MD, PhD,§ Frank P. Vleggaar, MD, PhD,|| Menno A. Brink, MD, PhD,¶ Ulrich H. W. Beuers, MD, PhD,Þ Ernst J. Kuipers, MD, PhD,* Henk R. van Buuren, MD, PhD,* and Marco J. Bruno, MD, PhD* Objective: Several diagnostic scoring systems for autoimmune pancreatitis (AIP) have been proposed including the Asian, HISORt (Histology, Imaging, Serology, Other organ involvement and Response to therapy), and International Consensus Diagnostic Criteria (ICDC), which have been compared by a few studies. We evaluated the diagnostic performance of these criteria in patients diagnosed with AIP between May 1992 and August 2011. Methods: Scoring systems were applied retrospectively using data obtained in the initial evaluation period, before pancreatic resection was performed. Results: One hundred fourteen cases with AIP were included. Eightytwo percent met the diagnostic criteria for AIP according to either the Asian, HISORt, or ICDC criteria. Only 33% met the Asian criteria, probably mainly related to a low rate of diagnostic pancreatography. In 18%, all scoring systems failed to confirm the diagnosis, even though these patients were considered to have a firm diagnosis of AIP. Conclusions: In this cohort of AIP patients, the 3 major diagnostic scoring systems for AIP proved to be complementary rather than overlapping. Our data indicate that one-fifth of our AIP patients do not meet any of these scoring systems. The ICDC, Asian, and HISORt criteria should be considered as useful clinical tools but not as criterion standard for the diagnosis. Key Words: autoimmune pancreatitis, IgG4, IgG4-related disease, diagnostic criteria (Pancreas 2014;43: 559Y564)
A
utoimmune pancreatitis (AIP) represents the pancreatic manifestation of immunoglobulin G4 (IgG4)Yrelated sclerosing disease that may affect not only the pancreas but also other organs including the extrapancreatic biliary tract, salivary glands, retroperitoneal tissues, and kidneys.1 Because AIP often
From the *Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam; †Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam; ‡Department of Pathology, Erasmus University Medical Center; and §Department of Pathology, Academic Medical Center, Amsterdam; ||Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht; and ¶Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands. Received for publication February 10, 2013; accepted October 28, 2013. M.J.v.H. and J.B. contributed equally to this study. Reprints: Marianne J. van Heerde, MD, Gravin van Stauffenstraat 15, 4854 EL Bavel, the Netherlands (e
