Ishikawa T, Itoh A, Kawashima H, Ohno E, Matsubara H, Itoh Y, Nakamura Y, Hiramatsu T, Nakamura M, Miyahara R, Ohmiya N, Goto H, Hirooka Y. Endoscopic ultrasound-guided fine needle aspiration in the differentiation of type 1 and type 2 autoimmune pancreatitis. World J Gastroenterol 2012; 18(29): 3883-3888 [PMID: 22876041 DOI: 10.3748/wjg.v18.i29.3883]
Corresponding Author of This Article
Dr. Yoshiki Hirooka, MD, Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. hirooka@med.nagoya-u.ac.jp
Article-Type of This Article
Brief Article
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Takuya Ishikawa, Akihiro Itoh, Hiroki Kawashima, Hiroshi Matsubara, Yuya Itoh, Takeshi Hiramatsu, Masanao Nakamura, Naoki Ohmiya, Hidemi Goto, Department of Gastroenterology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan
Eizaburo Ohno, Yosuke Nakamura, Ryoji Miyahara, Yoshiki Hirooka, Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan
Author contributions: Ishikawa T is the principal investigator of the study; Itoh A, Kawashima H and Ohno E were involved in diagnosis and clinical care of the subjects; Matsubara H, Itoh Y and Nakamura Y reviewed and reported the radiology; Hiramatsu T, Nakamura M and Miyahara R reviewed the histopathology; Ohmiya N and Goto H collated and analyzed the data; Hirooka Y and Ishikawa T designed this study; Hirooka Y participated in administrative and technical support of the manuscript and is a corresponding author; and all authors contributed to the drafting of the paper and revising it for important intellectual content.
Supported by The Research Committee of Intractable Pancreatic Diseases provided by the Ministry of Health, Labour, and Welfare of Japan
Correspondence to: Dr. Yoshiki Hirooka, MD, Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. hirooka@med.nagoya-u.ac.jp
Telephone: +81-52-7442602 Fax: +81-52-7442602
Received: November 4, 2011 Revised: January 18, 2012 Accepted: February 8, 2012 Published online: August 7, 2012
Abstract
AIM: To investigate the usefulness of endoscopic ultra-sound-guided fine needle aspiration (EUS-FNA) in the differentiation of autoimmune pancreatitis (AIP).
METHODS: We retrospectively reviewed 47 of 56 AIP patients who underwent EUS-FNA and met the Asian diagnostic criteria. On 47 EUS-FNA specimens, we evaluated the presence of adequate material and characteristic features of lymphoplasmacytic sclerosing pancreatitis (LPSP) and idiopathic duct-centric pancreatitis (IDCP) mentioned in the International Consensus Diagnostic Criteria and examined if these findings make a contribution to the differential diagnosis of type 1 and type 2 AIP. A disposable 22-gauge needle was used for EUS-FNA.
RESULTS: Adequate specimens including pancreatic tissue for differentiating AIP from cancer were obtained from 43 of 47 patients who underwent EUS-FNA. EUS-FNA was performed from the pancreatic head in 21 cases, which is known to be technically difficult when performed by core biopsy; there was no significant difference in the results compared with pancreatic body-tail. Nine of 47 patients met level 1 findings of LPSP and 5 patients met level 2 findings of LPSP. No one met level 1 findings of IDCP, but 3 patients met level 2 findings of IDCP. Of 10 seronegative cases, 2 cases were diagnosed with “definitive type 1 AIP”, and 3 cases were diagnosed with “probable type 2 AIP” when considering both the level 2 histological findings and response to steroids.
CONCLUSION: EUS-FNA is useful in the differentiation of type 1 and type 2 AIP, particularly in seronegative cases.
