ORIGINAL ARTICLE
Retrospective Comparison Between Preoperative Diagnosis by International Consensus Diagnostic Criteria And Histological Diagnosis in Patients With Focal Autoimmune Pancreatitis Who Underwent Surgery With Suspicion of Cancer Tsukasa Ikeura, MD,* So¨nke Detlefsen, MD,Þ Giuseppe Zamboni, MD,þ Riccardo Manfredi, MD,§ Riccardo Negrelli, MD,§ Antonio Amodio, MD,|| Francesco Vitali, MD,|| Armando Gabbrielli, MD,|| Luigi Benini, MD,|| Gu¨nter Klo¨ppel, MD,¶ Kazuichi Okazaki, MD,* Italo Vantini, MD,|| and Luca Frulloni, MD||
Objective: The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery. Methods: Thirty patients (type 1 AIP in 23 and type 2 AIP in 7) with a diagnosis of AIP based on histology of surgical specimens were classified according to ICDC based on their preoperative data. Results: Pancreatic core biopsies and diagnostic steroid trial were not preoperatively performed in any of the patients. Based on preoperative data, ICDC diagnosed 6 patients (20%) as having type 1 AIP and 24 (80%) as probable AIP. Assuming all patients had responded to a steroid trial preoperatively, ICDC would have diagnosed 8 patients (27%) as having type 1 AIP, 4 (13%) as type 2 AIP, 10 as AIPYnot otherwise specified (33%), and 8 (27%) as probable AIP. In the hypothetical situation, 7 of 8 type 1 AIP patients and 3 of 3 type 2 AIP patients would have been classified into the correct subtype of AIP. Conclusions: A steroid trial enhances the possibility of correctly diagnosing AIP by ICDC despite the lack of histology. However, some patients cannot be diagnosed as having AIP or be classified into the correct subtype without histology. Key Words: autoimmune pancreatitis, histology, diagnosis, criteria, radiology (Pancreas 2014;43: 698Y703)
A
utoimmune pancreatitis (AIP) is a unique pancreatic inflammation that is associated with autoimmunity.1Y5 Clinically, the disease is characterized by pancreatic enlargement, irregular narrowing of the main pancreatic duct (MPD), and a
From the *The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan; †Department of Pathology, Odense University Hospital, Odense, Denmark; Departments of ‡Pathology, §Radiology, and ||Medicine, Pancreas Center, University of Verona, Verona, Italy; and ¶Department of Pathology, University of Kiel, Kiel, Germany. Received for publication May 22, 2013; accepted January 22, 2014. Reprints: Tsukasa Ikeura, MD, The Third Department of Internal Medicine, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, 573-1191 Osaka, Japan (e
Retrospective Comparison Between Preoperative Diagnosis by International Consensus Diagnostic Criteria And Histological Diagnosis in Patients With Focal Autoimmune Pancreatitis Who Underwent Surgery With Suspicion of Cancer Tsukasa Ikeura, MD,* So¨nke Detlefsen, MD,Þ Giuseppe Zamboni, MD,þ Riccardo Manfredi, MD,§ Riccardo Negrelli, MD,§ Antonio Amodio, MD,|| Francesco Vitali, MD,|| Armando Gabbrielli, MD,|| Luigi Benini, MD,|| Gu¨nter Klo¨ppel, MD,¶ Kazuichi Okazaki, MD,* Italo Vantini, MD,|| and Luca Frulloni, MD||
Objective: The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery. Methods: Thirty patients (type 1 AIP in 23 and type 2 AIP in 7) with a diagnosis of AIP based on histology of surgical specimens were classified according to ICDC based on their preoperative data. Results: Pancreatic core biopsies and diagnostic steroid trial were not preoperatively performed in any of the patients. Based on preoperative data, ICDC diagnosed 6 patients (20%) as having type 1 AIP and 24 (80%) as probable AIP. Assuming all patients had responded to a steroid trial preoperatively, ICDC would have diagnosed 8 patients (27%) as having type 1 AIP, 4 (13%) as type 2 AIP, 10 as AIPYnot otherwise specified (33%), and 8 (27%) as probable AIP. In the hypothetical situation, 7 of 8 type 1 AIP patients and 3 of 3 type 2 AIP patients would have been classified into the correct subtype of AIP. Conclusions: A steroid trial enhances the possibility of correctly diagnosing AIP by ICDC despite the lack of histology. However, some patients cannot be diagnosed as having AIP or be classified into the correct subtype without histology. Key Words: autoimmune pancreatitis, histology, diagnosis, criteria, radiology (Pancreas 2014;43: 698Y703)
A
utoimmune pancreatitis (AIP) is a unique pancreatic inflammation that is associated with autoimmunity.1Y5 Clinically, the disease is characterized by pancreatic enlargement, irregular narrowing of the main pancreatic duct (MPD), and a
From the *The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan; †Department of Pathology, Odense University Hospital, Odense, Denmark; Departments of ‡Pathology, §Radiology, and ||Medicine, Pancreas Center, University of Verona, Verona, Italy; and ¶Department of Pathology, University of Kiel, Kiel, Germany. Received for publication May 22, 2013; accepted January 22, 2014. Reprints: Tsukasa Ikeura, MD, The Third Department of Internal Medicine, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, 573-1191 Osaka, Japan (e
