Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study

Atsushi Kanno, Atsushi Masamune, Fumiyoshi Fujishima, Takuji Iwashita, Yuzo Kodama, Akio Katanuma, Hirotaka Ohara, Masayuki Kitano, Hiroyuki Inoue, Takao Itoi, Nobumasa Mizuno, Hiroyuki Miyakawa, Rintaro Mikata, Atsushi Irisawa, Satoko Sato, Kenji Notohara, Tooru Shimosegawa

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Abstract

Background and Aims Histopathologic examination is critical for diagnosing autoimmune pancreatitis (AIP). However, specimens obtained using EUS-guided FNA (EUS-FNA) are not recommended for histopathologic diagnosis because of inadequate sample size volume. We evaluated EUS-FNA efficacy for AIP diagnosis using a 22G needle. Methods Seventy-eight patients exhibiting the imaging characteristics indicative of AIP in the pancreatic parenchyma and pancreatic duct underwent EUS-FNA with a 22G needle at 12 institutions between February 2013 and March 2014. Samples were evaluated for tissue sampling conditions, CD38- and IgG4-positive plasma cell counts, storiform fibrosis (SF), and obliterative phlebitis (OP). Results Tissue specimens containing >10, 5 to 10, and 1 to 4 high-power fields (HPFs) were obtained from 29 (37.2%), 18 (23.1%), and 15 (19.2%) of 78 patients, respectively. The mean ± standard deviation (SD) CD38- and IgG4-positive plasma cell counts were 23.2 ± 18.8/HPF and 5.1 ± 6.7/HPF, respectively. SF was detected in 49 of 78 patients (62.8%) and OP in 38 of 78 patients (48.7%). According to the International Consensus Diagnostic Criteria (ICDC), histopathologic levels corresponded to level 1 in 32, level 2 in 13, and unclassifiable in 17 patients. Hence, 45 of 78 patients (57.7%) could be diagnosed with lymphoplasmacytic sclerosing pancreatitis according to ICDC. Conclusions Pancreatic tissues with at least 1 HPF were obtained by EUS-FNA from approximately 80% of patients, and nearly 60% of patients were diagnosed with ICDC level 2 or higher. Our findings indicate that EUS-FNA with a 22G needle may be useful for the histopathologic diagnosis of AIP. (Clinical trial registration number: UMIN000010097.)

Original languageEnglish
Pages (from-to)797-804.e1
JournalGastrointestinal Endoscopy
Volume84
Issue number5
DOIs
Publication statusPublished - 2016 Nov 1

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Kanno, A., Masamune, A., Fujishima, F., Iwashita, T., Kodama, Y., Katanuma, A., Ohara, H., Kitano, M., Inoue, H., Itoi, T., Mizuno, N., Miyakawa, H., Mikata, R., Irisawa, A., Sato, S., Notohara, K., & Shimosegawa, T. (2016). Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study. Gastrointestinal Endoscopy, 84(5), 797-804.e1. https://doi.org/10.1016/j.gie.2016.03.1511