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Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Purpose

The aim of this study was to evaluate the feasibility and safety of endoscopic ultrasonography (EUS)-guided trucut biopsy (TCB) for diagnosis of autoimmune pancreatitis (AIP).

Methods

Fourteen patients with suspected AIP based on imaging studies underwent both EUS-guided fine-needle aspiration (FNA) and EUS-TCB for diagnosis of AIP and exclusion of pancreatic cancer (PC). According to the revised Japanese clinical diagnostic criteria, AIP was diagnosed in eight while the remaining six patients had pancreatitis of other etiologies. Pathologically, AIP was defined as lymphoplasmacytic sclerosing pancreatitis (LPSP), and sub-divided into two types: definite LPSP (d-LPSP) showing fulspectrum of LPSP and probable LPSP (p-LPSP) without obliterative phlebitis or abundant (>10 cells/hpf) IgG4-positive plasmacytes infiltration.

Results

PC was excluded in all patients. EUS-FNA resulted in three of eight patients with AIP were reported as p-LPSP, one was reported as normal, and 4 were inconclusive. One of six with non-autoimmune pancreatitis was diagnosed as p-LPSP on EUS-FNA, one as idiopathic chronic pancreatitis (ICP) and four were inconclusive. By using EUS-TCB, all AIP patients were diagnosed as LPSP (4 d-LPSP and 4 p-LPSP). Of the six patients with non-autoimmune pancreatitis, three were diagnosed as LPSP (1 d-LPSP and 2 p-LPSP) and three showed ICP on TCB. No complications were identified in any patient with either EUS-FNA or TCB.

Conclusion

EUS-TCB is a safe and accurate procedure for obtaining a histological diagnosis in patients with suspected AIP. EUS-TCB can serve as a rescue technique in cases of AIP lacking typical findings.

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Acknowledgments

We are deeply indebted to Mr. K Ishida (Aichi Cancer Center Hospital) for his expertise in histochemistry. This work was supported by the grants from the Ministry of Health, Labor and Welfare (to NM and KY), Ministry of Education, Culture, Sports, Science and Technology (to NM and SBHK), Pancreas Research Foundation of Japan (to NM), and The Japanese Foundation for Research and Promotion of Endoscopy (to NM).

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Authors and Affiliations

  1. Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Nobumasa Mizuno, Akira Sawaki, Noriyuki Hoki, Kazuo Hara, Tadayuki Takagi & Kenji Yamao

  2. Department of Medical Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India

    Vikram Bhatia

  3. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Waki Hosoda & Yasushi Yatabe

  4. Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Shigeru B. H. Ko & Hidemi Goto

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  1. Nobumasa Mizuno
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  2. Vikram Bhatia
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  3. Waki Hosoda
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  4. Akira Sawaki
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Correspondence to Nobumasa Mizuno.

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Mizuno, N., Bhatia, V., Hosoda, W. et al. Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA. J Gastroenterol 44, 742–750 (2009). https://doi.org/10.1007/s00535-009-0062-6

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  • DOI: https://doi.org/10.1007/s00535-009-0062-6

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