Comparison study of immunohistochemical staining for the diagnosis of type 1 autoimmune pancreatitis
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Various methods to evaluate immunohistochemical staining (IHC) for the diagnosis of type 1 autoimmune pancreatitis (AIP) have been proposed. Our goal was to determine the most useful IHC method for the diagnosis of AIP.
Specimens of AIP (18 patients), chronic pancreatitis (CP, 24 patients), and pancreatic ductal adenocarcinoma (PDA, 45 patients) were evaluated with IHC for immunoglobulin G (IgG), IgG1, IgG4, and CD138 (syndecan-1). The number of IHC-positive cells was counted in 3, 5, and 10 different high-power fields (HPFs) by selecting fields with the most numerous positive cells (hotspot) or by randomly selecting fields in the affected areas (random). We evaluated the mean number of IgG4-positive plasma cells (IgG4+)/HPF (mean IgG4+), the number of fields with >10 and >50 IgG4+ (NOF >10 and NOF >50 IgG4+), the ratio of IgG4+/IgG+, IgG4+/IgG1+, and IgG4+/CD138+.
Analysis with receiver operator characteristic curves revealed that accurate and practical parameters in 3 HPFs were mean IgG4+ with the hotspot method (sensitivity, 88.9; specificity, 92.8 %), mean IgG4+ with the random method (100, 95.7 %), and NOF >10 IgG4+ with the random method (94.4, 97.1 %). These results were as accurate as results from 5 HPFs to 10 HPFs. The combination of mean IgG4+ and IgG4+/IgG+ did not provide more accurate diagnosis for AIP than a single criterion itself.
Mean IgG4+ or NOF >10 IgG4+ with the random method in 3 HPFs was a useful and simple diagnostic method for AIP. The combined criteria of mean IgG4+ and IgG4+/IgG+ might not be required for accurate diagnosis of AIP.
KeywordsAutoimmune pancreatitis IgG4-related disease Lymphoplasmacytic sclerosing pancreatitis Immunohistochemical staining
We are indebted to Yukimi Itoh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences; Hitoshi Sano, Department of Gastroenterology, Gifu Prefectural Tajimi Hospital; and Hiroki Takada, Department of Gastroenterology, Kasugai Municipal Hospital for providing the tissue specimens, clinical information, and technical assistance with histological analysis.
Kenji Notohara, Takahiro Nakazawa, and Hirotaka Ohara received a Grant-in-Aid from the “Research for Intractable Disease’’ Program of the Ministry of Health, Labor and Welfare of Japan; and Takahiro Nakazawa and Itaru Naitoh received a Grants-in-Aid for Scientific Research from the Ministry of Culture and Science of Japan (23591015 to Takahiro Nakazawa and 23790803 to Itaru Naitoh). This study was supported in part by a research grant from the Pancreas Research Foundation of Japan and Aichi Cancer Research Foundation.
Conflict of interest
The authors declare that they have no conflict of interest.
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