Serological characteristics of autoimmune pancreatitis and its differential diagnosis from pancreatic cancer by using a combination of carbohydrate antigen 19-9, globulin, eosinophils and hemoglobin

Abstract

Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which may be misdiagnosed as pancreatic carcinoma. This study aims to verify new biomarkers for AIP and propose a serological pattern to differentiate AIP from pancreatic adenocarcinoma with routinely performed tests. In this study, data of serum samples were collected and compared between 25 patients with AIP and 100 patients with pancreatic carcinoma. Receiver operating characteristic analysis and logistic regression was performed to evaluate the diagnostic effect of serum parameters in differentiating AIP from pancreatic carcinoma alone or in combination. Among several serum markers observed in the two groups, carbohydrate antigen 19–9 (Ca19-9), globulin, eosinophils and hemoglobin were selected as the independent markers. Serum levels of Globulin, Eosinophil percentage in AIP group were significantly higher than in pancreatic cancer group (P<0.05), while hemoglobin and tumor marker CA19-9 levels were lower (P <0.05). The combination of these markers identified patients with AIP with 92% sensitivity and 79% specificity, which indicated relatively high diagnostic value. Elevated serum eosinophils, globulin, together with decreased hemoglobin level can be used as a preoperative indicator for AIP and can help to initiate diagnosis of AIP in time.

European Guideline on IgG4‐related digestive disease – UEG and SGF evidence‐based recommendations

“…Studies addressing the diagnostic accuracy of CA 19-9 to distinguish AIP from pancreatic cancer are summarized in Table 1. [21][22][23] Using different cut-offs for CA 19-9, sensitivity and specificity ranged from 56 to 84% and 73 to 96%, respectively. Sensitivity and specificity improved by using different combinations with other parameters (CA 19-9 plus IgG4 20,21 or CA 19-9, eosinophil percentage, globulin and haemoglobin 23 ), but no validation cohorts have confirmed those strategies with specific cut-offs.…”

“…[21][22][23] Using different cut-offs for CA 19-9, sensitivity and specificity ranged from 56 to 84% and 73 to 96%, respectively. Sensitivity and specificity improved by using different combinations with other parameters (CA 19-9 plus IgG4 20,21 or CA 19-9, eosinophil percentage, globulin and haemoglobin 23 ), but no validation cohorts have confirmed those strategies with specific cut-offs. CA 19-9 should be considered in the diagnostic work-up, not as a single and definitive marker of the presence or absence of pancreatic adenocarcinoma, but as a test to be interpreted together with other clinical, laboratory, and imaging characteristics of the patient.…”

“…Marc G Besselink 1 , Marco J Bruno 2 , László Czakó 3 , Marco del Chiaro 4 , Oleksandra Filippova 5 , Akihisa Fukuda 6 , Sebastien Gaujoux 7 , Phil A Hart 8 , Peter Hegyi 9 , Eduard Jonas 10 , Alisan Kahraman 11 , Alexander Kleger 12 , Olexander Kuryata 5 , Johanna Laukkarinen 13 , Markus M Lerch 14 , Giovanni Marchegiani 15 , Hanns‐Ulrich Marschall 16 , Celso Matos 17 , Yair Molad 18 , Dilek Oguz 19 , Aldis Pukitis 20 , Sohei Satoi 21 , John H Stone 22 , Joanne Verheij 23 , Niek de Vries 24 …”

Carbohydrate antigen 19-9 — tumor marker: Past, present, and future

“…Autoimmune pancreatitis is a subset of chronic pancreatitis that is often misdiagnosed as a PDAC. Serum CA 19-9 alone has limited diagnostic value in distinguishing autoimmune pancreatitis, but combinations with different biochemical markers (such as IgG4, hemoglobin, eosinophil, and globulin) yield good diagnostic value[ 41 ].…”

Pancreatitis autoinmune

“…Múltiples ensayos internacionales resaltan la peculiaridad de la asociación regional y étnica de los hallazgos patológicos y clínicos, así como el perfil de presentación, que describe marcadas diferencias entre la PAI de tipo 1 y 2 5 .…”