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Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels.
Pancreatology. 2014 Sep-Oct; 14(5):366-72.P

Abstract

BACKGROUND/OBJECTIVES

To distinguish autoimmune pancreatitis (AIP), especially focal type, from pancreatic cancer, is a greatest challenge for clinician. The aim of the study is to compare the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of combined serum IgG4 and CA19-9 levels to differentiate AIP from pancreatic cancer by HISORt, Asian and international consensus diagnostic criteria.

METHODS

We measured serum IgG4, CEA, and CA19-9 levels in 188 AIP patients, 86 non-AIP chronic pancreatitis patients, and 130 pancreatic cancer patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were compared with different diagnostic criteria. We also compared the diagnostic performance in patients with or without jaundice.

RESULTS

The serum level of IgG4 was significantly higher in AIP than those in non-AIP chronic pancreatitis and pancreatic cancer. The optimal cutoffs of IgG4 and CA19-9 to differentiate AIP from pancreatic cancer were 175 mg/dL and 85.0 U/ml based on ROC analysis. Combining IgG4 level over 280 mg/dL and CA19-9 below 85.0 U/ml could yield a best diagnostic accuracy (85.6%) to distinguishing AIP from pancreatic cancer in all of the HISORt, Asian and international consensus diagnostic criteria. With the combination of serological test, focal type AIP could be diagnosed with comparable accuracy as diffuse type AIP.

CONCLUSIONS

Our study demonstrated that combined use of serum IgG4 (over 280 mg/dL) and CA19-9 9 (below 85.0 U/ml) together increases the diagnostic accuracy to distinguish AIP from pancreatic cancer non-invasively, especially in focal type autoimmune pancreatitis.

Authors+Show Affiliations

Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: yutingchang@ntu.edu.tw.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25278306

Citation

Chang, Ming-Chu, et al. "Increase Diagnostic Accuracy in Differentiating Focal Type Autoimmune Pancreatitis From Pancreatic Cancer With Combined Serum IgG4 and CA19-9 Levels." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 14, no. 5, 2014, pp. 366-72.
Chang MC, Liang PC, Jan S, et al. Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels. Pancreatology. 2014;14(5):366-72.
Chang, M. C., Liang, P. C., Jan, S., Yang, C. Y., Tien, Y. W., Wei, S. C., Wong, J. M., & Chang, Y. T. (2014). Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 14(5), 366-72. https://doi.org/10.1016/j.pan.2014.07.010
Chang MC, et al. Increase Diagnostic Accuracy in Differentiating Focal Type Autoimmune Pancreatitis From Pancreatic Cancer With Combined Serum IgG4 and CA19-9 Levels. Pancreatology. 2014 Sep-Oct;14(5):366-72. PubMed PMID: 25278306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels. AU - Chang,Ming-Chu, AU - Liang,Po-Chin, AU - Jan,Shiow, AU - Yang,Ching-Yao, AU - Tien,Yu-Wen, AU - Wei,Shu-Chen, AU - Wong,Jau-Min, AU - Chang,Yu-Ting, Y1 - 2014/07/25/ PY - 2014/01/07/received PY - 2014/07/15/revised PY - 2014/07/16/accepted PY - 2014/10/4/entrez PY - 2014/10/4/pubmed PY - 2015/6/17/medline KW - Autoimmune pancreatitis KW - CA19-9 KW - Diagnosis KW - Focal type KW - IgG4 KW - Pancreatic cancer SP - 366 EP - 72 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 14 IS - 5 N2 - BACKGROUND/OBJECTIVES: To distinguish autoimmune pancreatitis (AIP), especially focal type, from pancreatic cancer, is a greatest challenge for clinician. The aim of the study is to compare the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of combined serum IgG4 and CA19-9 levels to differentiate AIP from pancreatic cancer by HISORt, Asian and international consensus diagnostic criteria. METHODS: We measured serum IgG4, CEA, and CA19-9 levels in 188 AIP patients, 86 non-AIP chronic pancreatitis patients, and 130 pancreatic cancer patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were compared with different diagnostic criteria. We also compared the diagnostic performance in patients with or without jaundice. RESULTS: The serum level of IgG4 was significantly higher in AIP than those in non-AIP chronic pancreatitis and pancreatic cancer. The optimal cutoffs of IgG4 and CA19-9 to differentiate AIP from pancreatic cancer were 175 mg/dL and 85.0 U/ml based on ROC analysis. Combining IgG4 level over 280 mg/dL and CA19-9 below 85.0 U/ml could yield a best diagnostic accuracy (85.6%) to distinguishing AIP from pancreatic cancer in all of the HISORt, Asian and international consensus diagnostic criteria. With the combination of serological test, focal type AIP could be diagnosed with comparable accuracy as diffuse type AIP. CONCLUSIONS: Our study demonstrated that combined use of serum IgG4 (over 280 mg/dL) and CA19-9 9 (below 85.0 U/ml) together increases the diagnostic accuracy to distinguish AIP from pancreatic cancer non-invasively, especially in focal type autoimmune pancreatitis. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/25278306/Increase_diagnostic_accuracy_in_differentiating_focal_type_autoimmune_pancreatitis_from_pancreatic_cancer_with_combined_serum_IgG4_and_CA19_9_levels_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(14)00957-0 DB - PRIME DP - Unbound Medicine ER -