Laparoscopic and Percutaneous Core Needle Biopsy Plays a Central Role for the Diagnosis of Autoimmune Pancreatitis in a Single-Center Study From Denmark
Laparoscopic and Percutaneous Core Needle Biopsy Plays a Central Role for the Diagnosis of Autoimmune Pancreatitis in a Single-Center Study From Denmark
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DOI：
10.1097/mpa.0000000000000312
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发表时间：
2015-08-01
期刊：
影响因子：
2.9
通讯作者：
de Muckadell, Ove B. Schaffalitzky
中科院分区：
文献类型：
--
作者：
Detlefsen, Sonke;Mortensen, Michael Bau;de Muckadell, Ove B. Schaffalitzky
目的 本研究的目的是描述丹麦自身免疫性胰腺炎 (AIP) 的诊断，并测试国际共识诊断标准 (ICDC) 在地理上明确的队列中的有效性。方法纳入 2007 年至 2013 年在欧登塞大学医院诊断为 AIP 的所有患者（n = 30；平均随访时间为 26.2 个月）。根据 ICDC 回顾性分析腹腔镜或经皮超声引导下的空心针活检 (CNB)、切除标本、超声内镜 (EUS)、EUS 引导下的 CNB、计算机断层扫描、血清免疫球蛋白 G4 (IgG4) 和胰腺造影的数据。 结果 20 例患者被诊断为 1 型，8 例为 2 型，2 例未明确指定 AIP。回顾性应用 ICDC 时，28 名患者（93%）能够正确分类。 44% 的 1 型患者和 0% 的 2 型患者血清 IgG4 升高。40% 的 1 型患者和 13% 的 2 型患者观察到其他器官受累，但仅 2 型患者出现炎症性肠病（P = 0.001）。一名患者患有 IgG4 相关的慢性脾周炎，这是 IgG4 相关疾病迄今为止未描述的表现。 21 名活检患者中有 19 名 (91%) 具有 AIP 的诊断性 CNB 特征。计算机断层扫描、EUS 和胰腺造影显示高度提示或支持 AIP 的特征分别为 68%、72% 和 71%。 结论 腹腔镜或经皮超声引导 CNB 对 AIP 的敏感性最高。 ICDC 可以回顾性地正确诊断 93% 的患者。
Objectives The aims of this study were to describe the diagnosis of autoimmune pancreatitis (AIP) in Denmark and to test the usefulness of the International Consensus Diagnostic Criteria (ICDC) on a geographically well-defined cohort.Methods All patients diagnosed with AIP at Odense University Hospital from 2007 to 2013 were included (n = 30; mean follow-up, 26.2 months). Data from laparoscopic or percutaneous ultrasound-guided core needle biopsy (CNB), resection specimens, endoscopic ultrasound (EUS), EUS-guided CNB, computed tomography, serum immunoglobulin G4 (IgG4), and pancreatography were retrospectively analyzed according to ICDC.Results Twenty patients were diagnosed with type 1, 8 with type 2, and 2 with not otherwise specified AIP. Twenty-eight patients (93%) could correctly be classified when ICDC were retrospectively applied. Serum IgG4 was elevated in 44% of type 1 and 0% of type 2. Other organ involvement was observed in 40% of type 1 and 13% of type 2, but inflammatory bowel disease only in type 2 (P = 0.001). One patient had IgG4-related chronic perisplenitis as a hitherto undescribed manifestation of IgG4-related disease. Nineteen (91%) of 21 biopsied patients had diagnostic CNB features of AIP. Computed tomography, EUS, and pancreatography showed features highly suggestive or supportive of AIP in 68%, 72%, and 71%, respectively.Conclusions Laparoscopic or percutaneous ultrasound-guided CNB had the highest sensitivity for AIP. The ICDC could retrospectively correctly diagnose 93% of the patients.