Comparison of the multidetector-row computed tomography findings of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma

Yata, Masaki; Suzuki, Kôjiro; Furuhashi, Naohiro; Kawakami, Keisuke; Kawai, Yuichi; Naganawa, Shinji

doi:10.1016/j.crad.2015.10.024

Cited by 25 publications

(16 citation statements)

References 29 publications

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“…To date, characteristic reported imaging findings for IgG4-SC include: (1) concentric bile duct wall thickening extending along the long axis; (2) smooth inner/outer margins; (3) visibility of patent bile duct in the strictures and mildness of upper bile duct dilatation; and (4) continuous bile duct wall thickening covering intrahepatic and extrahepatic bile ducts. However, the prevalence of these findings varies depending on the report; more reliable findings other than the abnormalities in the pancreas (presence of AIP) have yet to be reported [87][88][89][90][91]. Although Kim et al reported that MRCP can detect characteristic findings for PSC, such as multiple intrahepatic bile duct stenosis or pruned-tree appearance, the spatial resolution of MRCP falls short of that of ERC [92].…”

Section: Cqi-4)mentioning

confidence: 99%

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

122

143

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IgG4‐related sclerosing cholangitis (IgG4‐ SC ) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4‐related disease. Although clinical diagnostic criteria of IgG4‐ SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4‐ SC are available. Because the evidence level of most articles retrieved through searching the PubMed, Cochrane Library, and Igaku Chuo Zasshi databases was below C based on the systematic review evaluation system of clinical practice guidelines MINDS 2014, we developed consensus guidelines using the modified Delphi approach. Three committees (a guideline creating committee, an expert panelist committee for rating statements according to the modified Delphi method, and an evaluating committee) were organized. Eighteen clinical questions ( CQ s) with clinical statements were developed regarding diagnosis (14 CQ s) and treatment (4 CQ s). Recommendation levels for clinical statements were set using the modified Delphi approach. The guidelines explain methods for accurate diagnosis, and safe and appropriate treatment of IgG4‐ SC .

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Section: Cqi-4)mentioning

confidence: 99%

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

122

143

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“…IRSC responses well to the steroids treatment and should not be treated by operation. Sometimes, differential diagnosis of IRSC and MOJ can be very difficult 8 , 9 . The differential diagnostic roles of the serum CA19-9 has not been reported between IRSC and MOJ.…”

Section: Introductionmentioning

confidence: 99%

Differential diagnostic roles of the serum CA19-9, total bilirubin (TBIL) and the ratio of CA19-9 to TBIL for benign and malignant

Liu¹,

Liu²,

Wang³

et al. 2018

J. Cancer

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Background: Obstructive jaundice is one of the most common symptoms which can be caused by both malignant and benign hepato-biliary-pancreatic diseases. The differences and the differential diagnostic roles of the serum CA19-9, total bilirubin (TBIL) and especially, the ratio of CA19-9 to TBIL in these patients have not been well elucidated. This study compared the differences and the differential diagnostic roles of the increase-folds of the serum CA19-9, TBIL and the ratio of increase-folds of CA19-9 to increase-folds of TBIL in 508 cases of malignant (MOJ) and benign (BOJ) obstructive jaundice patients.Methods: Totally, 508 cases of obstructive jaundice patients with pathological results were retrospectively enrolled. 342 cases were MOJ, including gallbladder adenocarcinoma, extrahepatic cholangiocarcinoma, periampullar adenocarcinoma and pancreatic adenocarcinoma.The other 166 cases were BOJ, including cholelithiasis, primary sclerosing cholangitis (PSC), IgG4 related sclerosing cholangitis (IRSD), inflammatory stricture of bile duct, and adenoma. The data of the increase-folds of serum CA19-9, TBIL and the ratio of increase-folds of CA19-9 to increase-folds of TBIL was collected and analyzed. The ROC (receiver operating characteristic) curve was adopted to determine the optimal cutoff value to evaluate their differential diagnostic roles.Results: The CA19-9 was elevated in 94.15% of the MOJ, compared to 67.10% in BOJ (P<0.0001). The increase-folds of the CA19-9 (76.52±15.04 vs 3.55±0.41, P< 0.0001) and the increase-folds of TBIL (7.10±0.25 vs 5.95±0.36, P=0.0034) and the ratio (14.96±5.05 vs 0.79±0.93, P=0.0026) in MOJ were significantly higher than BOJ. The ROC curves indicated that the TBIL showed minimal differential diagnostic power (AUC=0.590), the increase-folds of CA19-9 and the ratio showed stronger differential diagnostic power (AUC=0.815 and AUC=0.889, respectively). The optimal value of the increase-folds of serum CA19-9 and the ratio for differential diagnosis was 4.5 and 0.88, respectively. Further, the combination of the increase-folds of serum CA19-9 and the ratio could increase the specificity and accuracy of the diagnosis of MOJ.Conclusion: The serum CA19-9, TBIL and the ratio in MOJ and BOJ are significantly different. The ratio of the increase-folds of CA19-9 to increase-folds of TBIL has stronger differential diagnostic roles than the increase-folds of CA19-9 or TBIL alone. The combination of the increase-folds of the CA19-9 and the ratio can further improve the specificity and accuracy of the diagnosis of MOJ.

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“…Cross-sectional study, CT and MRI have proven difficult to use for differentiation from CCA [ 24 – 27 ]. IgG4-SC can present with a focal/segmental or diffused biliary stricture [ 26 , 27 ]. Patients with concomitant AIP and other organ involvement might demonstrate characteristics of organ involvement that raise suspicions of IgG4-SC.…”

Section: Discussionmentioning

confidence: 99%

Isolated IgG4-related sclerosing cholangitis misdiagnosed as malignancy in an area with endemic cholangiocarcinoma: a case report

2017

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BackgroundThe most common cause of perihilar obstruction is cholangiocarcinoma, especially in Thailand. Benign perihilar stricture represents less than 20% of cases. IgG4-related disease and IgG4-related sclerosing cholangitis, however, have been receiving increased recognition. Isolated IgG4-related sclerosing cholangitis is less common. The preoperative diagnosis of IgG4-related sclerosing cholangitis without pancreatic involvement is very difficult because the clinical presentation and preoperative evaluation are extremely difficult to distinguish from perihilar cholangiocarcinoma.Case presentationWe report the case of a 56-year-old man who presented with obstructive jaundice with preoperative imaging showing proximal common bile duct obstruction. He underwent right lobe liver hepatectomy with extrahepatic bile duct resection and regional lymph node dissection due to high suspicion of malignancy. The pathological report showed severe acute and chronic inflammation of the bile duct with morphology and immunohistochemistry suggestive of IgG4-related sclerosing cholangitis.ConclusionsIgG4-related sclerosing cholangitis with perihilar obstruction should be considered even in areas where cholangiocarcinoma is endemic.

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Comparison of the multidetector-row computed tomography findings of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma

Cited by 25 publications

References 29 publications

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Differential diagnostic roles of the serum CA19-9, total bilirubin (TBIL) and the ratio of CA19-9 to TBIL for benign and malignant

Isolated IgG4-related sclerosing cholangitis misdiagnosed as malignancy in an area with endemic cholangiocarcinoma: a case report

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