Diagnostic efficay of biopsy in autuimmune pancreatitis

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Our aim was to clarify which of these biopsy specimens and counting method could be a useful tool for supporting the diagnosis of autoimmune pancreatitis(AIP). We retrospectively evaluated biopsy specimens from pancreas, stomach, duodenum, duodenal papilla, colon, liver, bile duct, and minor salivary gland in 36 patients with AIP. The positive IgG4 immunostaining of the duodenal papilla in one high-power field (HPF) showed the highest sensitivity (52%) and accuracy (73%) among the 8 sites. It also showed the highest sensitivity among 4 different counting methods (IgG4 immunostaining in one HPF and 3 HPFs, both IgG4 immunostaining and IgG/IgG4 ratio in one HPF and 3 HPFs), but there were no significant differences with respect to specificity and accuracy.IgG4 immunostaining of swollen duodenal papilla with more than 10 IgG4-positive plasma cells in at least one HPF is useful for supporting the diagnosis of AIP.