Endoscopic Ultrasonography‐Guided Fine Needle Aspiration Can Be Used to Rule Out Malignancy in Autoimmune Pancreatitis Patients

Sugimoto, Mitsuru; Takagi, Tadayuki; Suzuki, Rei; Konno, Naoki; Asama, Hiroyuki; Watanabe, Ko; Nakamura, Jun; Kikuchi, Hitomi; Waragai, Yuichi; Takasumi, Mika; Sato, Yuki; Hikichi, Takuto; Ohira, Hiromasa

doi:10.1002/jum.14265

Cited by 21 publications

(14 citation statements)

References 53 publications

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“…At present, the accurate differential diagnosis of AIP and PC before surgery has become a hot topic for clinicians and scholars. The value of CT examination in the diagnosis and staging of PC has been clinically recognized, and it is regarded as the best imaging method for PC examination (18,19). In recent years, CT has been used increasingly in the differential diagnosis of AIP and PC, and the CT characteristics of the 2 diseases are significantly different.…”

Section: Discussionmentioning

confidence: 99%

Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis

Zhao¹,

Li²,

An³

et al. 2021

Gland Surg

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Background:To analyze the atypical enhanced computed tomography (CT) signs of pancreatic cancer (PC) and compare them with those of autoimmune pancreatitis (AIP) to explore the differential diagnosis value of CT. Methods:The clinical data of 36 AIP (AIP group) and 38 PC patients (PC group), who were admitted to our hospital from January 2013 to June 2020 and confirmed by surgical biopsy or hormone therapy, were retrospectively analyzed. Participants in both groups were examined by CT, the imaging signs of the 2 groups were analyzed, and the results of CT examination were compared.Results: In the PC group, the density of the lesions on the CT scan was mostly reduced, the pancreas was not swollen, and the kidneys were not involved. The bile duct wall was thickened with a sausage-like appearance, enveloped edges were rare, blood vessels were invaded, lymph nodes were enlarged, and the pancreatic duct was truncated. The findings of the AIP group were the opposite. The difference in the proportion of participants with the above-mentioned CT features between the 2 groups was statistically significant (P<0.05). The shape of the lesions in the AIP group was mainly elongated, of uneven density, and the density of enhanced scanning was medium to high. The predominant shape of the lesions in PC participants was spherical, and the density was uniform. The enhanced scan was mainly low-density. The difference in shape and density between the 2 groups was also statistically significant (P<0.05). The CT values of the plain scan, intravenous phase, and delayed phase in the AIP group were significantly higher than those in the PC group (P<0.05). Conclusions:The imaging signs of AIP and PC overlap. Examination with CT is of great value in the differential diagnosis between AIP and PC. Familiarity with and mastery of the CT signs of AIP and PC can help to improve the accuracy of clinical diagnosis and provide a reliable basis for patients' follow-up treatment.

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Section: Discussionmentioning

confidence: 99%

Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis

Zhao¹,

Li²,

An³

et al. 2021

Gland Surg

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“…Several studies reported the diagnostic difficulty of AIP by EUS-FNA with the limited sensitivity of 0-19% for pathologically definite diagnosis of LPSP, because EUS-FNA could not provide sufficient tissue samples for histological evaluation [26,27,[33][34][35]. Iwashita et al reported the improved sensitivity of 43% using a 19-gauge FNA needle [29].…”

Section: Discussionmentioning

confidence: 99%

“…Novel needles have been developed with side holes or dedicated tip designs to obtain adequate tissue samples for histological evaluation and are called EUS-guided fine needle biopsy (EUS-FNB) needles [15][16][17][18][19][20][21][22][23][24]. Recently, the diagnostic yield of EUS-FNA for AIP has been reported [25][26][27][28][29][30][31][32][33][34][35], and EUS-FNB is expected to provide the better yield [25,36].…”

Section: Introductionmentioning

confidence: 99%

Role of Endoscopic Ultrasonography-Guided Fine Needle Aspiration/Biopsy in the Diagnosis of Autoimmune Pancreatitis

Noguchi

Nakai

Hirano³

et al. 2020

Diagnostics

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Type 1 autoimmune pancreatitis (AIP) is histologically characterized by lymphoplasmacytic sclerosing pancreatitis (LPSP). Recently, the diagnostic yield of endoscopic ultrasonography-guided fine needle aspiration/biopsy (EUS-FNA/B) for AIP has been reported. However, its role in the diagnostic flow of AIP is not fully elucidated. We retrospectively reviewed 53 consecutive patients who were suspected with AIP and underwent EUS-FNA/B. We evaluated the contribution of EUS-FNA/B to the diagnosis of AIP before considering response to steroid therapy among patients with diffuse enlargement of the pancreas and those with focal enlargement, respectively. Twenty-two patients showed diffuse pancreatic enlargement and 31 showed focal enlargement. The final diagnosis was definitive AIP in 32 patients, probable AIP in 2, possible AIP in 1, and mass-forming focal pancreatitis in 18. There was no change in diagnosis after EUS-FNA/B among patients with diffuse pancreatic enlargement, while diagnosis changed in 38.7% (12/31) among those with focal enlargement—there was a probable to definitive diagnosis in 4 patients, unspecified to definitive in 3, and unspecified to probable in 5. EUS-FNB provided a significantly higher sensitivity for typical pathological findings of LPSP than EUS-FNA, and 10 patients were diagnosed as pathologically definitive AIP by EUS-FNB, though none were by EUS-FNA (p = 0.002). EUS-FNA/B was useful in the diagnosis of focal type AIP, and steroid therapy could be introduced after the diagnosis was confirmed. Meanwhile, EUS-FNA/B provided no contribution to diagnosis of diffuse type AIP. EUS-FNB showed a higher diagnostic yield than FNA.

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“…Based on these data, some authors have proposed FNA to rule out malignancy. A retrospective study on FNA (18-, 22-, and 25-gauge needles) in 40 AIP patients reported a histological diagnosis of AIP only in six patients (15%), with a single patient (2.5%) misdiagnosed with acinar cell carcinoma [ 8 ]. Among the remaining AIP patients without a histological diagnosis, the authors found significant differences in the radiological features and Ca19.9 levels compared with those with pancreatic cancer and inconclusive FNA.…”

Section: Fine-needle Aspiration (Fna) and Fine-needle Biopsy (Fnb)mentioning

confidence: 99%

The Role of EUS-Guided FNA and FNB in Autoimmune Pancreatitis

2021

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Autoimmune pancreatitis (AIP) is an increasingly recognized disease classified into two different subtypes based on histology. According to the International Diagnostic Criteria (ICDC), the diagnosis is achieved using a combination of different criteria. In patients presenting with a typical imaging appearance, the diagnosis may be straightforward, and steroid treatment is recommended, even without histological confirmation. In patients with atypical imaging or mass-forming appearance, the differential diagnosis with pancreatic cancer is challenging and crucial for treatment strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition has been proposed to achieve a histological diagnosis. Fine-needle aspiration (FNA) was first proposed to aspirate cells from pancreatic lesions. Despite excellent results in terms of sensitivity for pancreatic cancer, the data are disappointing regarding the diagnosis of AIP. The recent development of new needles allowing fine-needle biopsy (FNB) has been associated with improved diagnostic accuracy based on preserving the tissue architecture, which is necessary to detect the typical histological features of AIP. However, the published literature on the role of EUS-guided FNA and FNB is limited and mainly focused on type 1 AIP. The present study aimed to review the available literature on the role of EUS-guided FNA and FNB in the diagnosis of AIP.

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Endoscopic Ultrasonography‐Guided Fine Needle Aspiration Can Be Used to Rule Out Malignancy in Autoimmune Pancreatitis Patients

Cited by 21 publications

References 53 publications

Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis

Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis

Role of Endoscopic Ultrasonography-Guided Fine Needle Aspiration/Biopsy in the Diagnosis of Autoimmune Pancreatitis

The Role of EUS-Guided FNA and FNB in Autoimmune Pancreatitis

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