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

研究成果: Article査読

13 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)834-843
ページ数10
ジャーナルPancreatology
20
5
DOI
出版ステータスPublished - 2020 7月

ASJC Scopus subject areas

  • 内分泌学、糖尿病および代謝内科学
  • 肝臓学
  • 消化器病学

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