Efficacy and limitations of the histological diagnosis of type 1 autoimmune pancreatitis with endoscopic ultrasound-guided fine needle biopsy with large tissue amounts

Kenji Notohara, Terumi Kamisawa, Atsushi Kanno, Itaru Naitoh, Eisuke Iwasaki, Kyoko Shimizu, Yasuhiro Kuraishi, Masayo Motoya, Yuzo Kodama, Satomi Kasashima, Takayoshi Nishino, Kensuke Kubota, Junichi Sakagami, Tsukasa Ikeura, Shigeyuki Kawa, Kazuichi Okazaki

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: We examined the efficacy and limitations of acquiring large specimens by endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for diagnosing type 1 autoimmune pancreatitis (AIP). Methods: Patients from 12 institutions with non-neoplastic diseases or pancreatic ductal adenocarcinoma (PDAC) with large EUS-FNB specimens were investigated. Slides stained with hematoxylin-eosin, elastic, IgG4, and IgG stains were evaluated. The IgG4- and IgG-positive cell numbers were counted in three foci. The diagnoses were based on the Japan Pancreas Society 2011 (JPS 2011) criteria and the International Consensus Diagnostic Criteria (ICDC). Results: We analyzed 85 non-neoplastic (definite type 1 AIP in 73/85 based on the ICDC) cases and 64 PDAC cases. IgG4-positive cells were numerous (>10 in 85.9%), and the IgG4/IgG ratios were high (>40% in 81.2%). Plasma cell crushing by an artifact caused unsuccessful immunostaining, notably in smaller samples. Tissue lengths were an important factor for the presence of storiform fibrosis and obliterative phlebitis, but storiform fibrosis was equivocal even in large tissues. A definite or possible histological diagnosis was achieved in 45.9% (39/85) and 41.2% (35/85), respectively, and contributed to the definite final diagnosis of type 1 AIP in 33.3% (ICDC) and 55.6% (JPS 2011) in cases with segmental/focal lesions. In the PDAC group, >10 IgG4-positive cells was rare (2/58), but elastic stains revealed fibrous venous occlusions in 10.3% (6/58). Conclusions: EUS-FNB with large tissue amounts was useful for diagnosing type 1 AIP, notably by facilitating successful IgG4 immunostaining, but definite diagnosis may not be achieved even in cases with large specimens.

Original languageEnglish
Pages (from-to)834-843
Number of pages10
JournalPancreatology
Volume20
Issue number5
DOIs
Publication statusPublished - 2020 Jul

Keywords

  • Artifacts
  • Immunoglobulin G4-related disease
  • Immunohistochemistry
  • Pancreatic carcinoma
  • Pathology

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

Fingerprint Dive into the research topics of 'Efficacy and limitations of the histological diagnosis of type 1 autoimmune pancreatitis with endoscopic ultrasound-guided fine needle biopsy with large tissue amounts'. Together they form a unique fingerprint.

  • Cite this

    Notohara, K., Kamisawa, T., Kanno, A., Naitoh, I., Iwasaki, E., Shimizu, K., Kuraishi, Y., Motoya, M., Kodama, Y., Kasashima, S., Nishino, T., Kubota, K., Sakagami, J., Ikeura, T., Kawa, S., & Okazaki, K. (2020). Efficacy and limitations of the histological diagnosis of type 1 autoimmune pancreatitis with endoscopic ultrasound-guided fine needle biopsy with large tissue amounts. Pancreatology, 20(5), 834-843. https://doi.org/10.1016/j.pan.2020.05.026