The clinical utility of immunoglobulin G4 in the evaluation of autoimmune pancreatitis and pancreatic adenocarcinoma Journal Article
| Authors: | Pak, L. M.; Schattner, M. A.; Balachandran, V.; D'Angelica, M. I.; DeMatteo, R. P.; Kingham, T. P.; Jarnagin, W. R.; Allen, P. J. |
| Article Title: | The clinical utility of immunoglobulin G4 in the evaluation of autoimmune pancreatitis and pancreatic adenocarcinoma |
| Abstract: | Background: Elevation in the serum immunoglobulin-G4 (IgG4) level has been used as a diagnostic marker to distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), but its true utility is ill-defined. This study evaluates the clinical utility of IgG4 in differentiating AIP from PDAC. Methods: All patients evaluated in the hepatopancreaticobiliary surgery clinics with measured serum IgG4 were included. Patients were divided into normal IgG4 (<135 mg/dL) and elevated IgG4 (≥135 mg/dL) groups. The final diagnosis was determined by operative pathology when available or by clinical outcome. The sensitivity, specificity, PPV, and NPV of IgG4 for diagnosing AIP was assessed. Results: Between 1997 and 2015, 298 patients were identified. Normal IgG4 levels were present in 85% of patients (254/298), while 15% (44/298) were elevated. The overall prevalence of AIP was 17% (52/298). The sensitivity and specificity of IgG4 for AIP was 67% and 96%, respectively; however, the PPV was only 80%, including a 9% occurrence of PDAC in patients with an elevated IgG4. Conclusion: In this study of selected patients who underwent IgG4 testing, 9% of elevated IgG4 patients had PDAC. The overreliance on IgG4 as diagnostic for AIP may lead to mis-diagnosis and delayed treatment for PDAC. © 2017 International Hepato-Pancreato-Biliary Association Inc. |
| Keywords: | adult; human tissue; aged; major clinical study; outcome assessment; sensitivity and specificity; prevalence; diagnostic value; pancreas adenocarcinoma; immunoglobulin blood level; pancreas biopsy; predictive value; immunoglobulin g4; autoimmune pancreatitis; diagnostic test accuracy study; very elderly; human; male; female; article |
| Journal Title: | HPB |
| Volume: | 20 |
| Issue: | 2 |
| ISSN: | 1365-182X |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2018-02-01 |
| Start Page: | 182 |
| End Page: | 187 |
| Language: | English |
| DOI: | 10.1016/j.hpb.2017.09.001 |
| PROVIDER: | scopus |
| PUBMED: | 29033025 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 March 2018 -- Source: Scopus |
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MSK Authors
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574Dematteo -
411Allen -
554Jarnagin -
448D'Angelica -
268Kingham -
97Schattner -
58Balachandran -
16Ma
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