The Combined Measurement of Total Serum IgG and IgG4 May Increase Diagnostic Sensitivity for Autoimmune Pancreatitis Without Sacrificing Specificity, Compared.

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The Combined Measurement of Total Serum IgG and IgG4 May Increase Diagnostic Sensitivity for Autoimmune Pancreatitis Without Sacrificing Specificity, Compared With IgG4 Alone Tae Jun Song , MD1 , Myung-Hwan Kim , MD , PhD1 , Sung-Hoon Moon , MD1 , Jun Bum Eum , MD1 , Do Hyun Park , MD , PhD1 ,Sang Soo Lee , MD , PhD 1 , Dong Wan Seo , MD , PhD1 and S ung Koo Lee , MD, PhD1 Am J Gastroenterol 2010;105:1655–1660 R3. Chung Hoehoon / Prof. Dong Seokho

Introduction Autoimmune pancreatitis (AIP) Japanese criteria Increasingly being recognized to be a worldwide entity Lack of a simple diagnostic test No international consensus on AIP Japanese criteria In 2002, the Japan Pancreas Society first proposed Based on the use of imaging, serology, and histology Serological criteria included elevated titers of γ –globulin, IgG, autoantibodies . In 2006, immunoglobulin (Ig) G4 was newly added

Asian diagnostic criteria Proposed by a consensus of Japanese and Korean pancreatologists γ -globulin was deleted from serological criteria HISORt criteria Serum IgG4 alone The principal aim of this study To find whether combined measurement of total serum IgG and IgG4 could increase diagnostic sensitivity for AIP while maintaining specificity To determine the utility of autoantibodies in diagnosing AIP

Methods AIP group Approved by the Institutional Review Board of Asan Medical Center January 2003 ~ June 2009 82 patients Prospectively collected Total serum IgG and IgG4 ANA and RF be assayed All patients fulfilled : Asian diagnostic criteria or : HISORt criteria

As a comparison group 110 patients with pancreatic cancer were enrolled January 2008 ~ June 2009 prospectively collected total serum IgG and IgG4 were measured Diagnosis : confirmed by pancreatic histology and / or cytology

Interpretation of serological testing Estimated the sensitivity and specificity of total serum IgG and IgG4 : diagnosis and differentiation of AIP from pancreatic cancer Cutoff value by the Japan Pancreas Society : total IgG ≥ 1800 mg / dl IgG4 ≥ 135 mg / dl Seropositivity for combined measurement of total serum IgG and IgG4 : elevation of either total IgG or IgG4. Seropositivity of ANA : elevation of titer more than 1:80

Results

Clinical findings

Sensitivity of individual tests P<0.05 P=0.125

Sensitivity of combined measurements

Specificity of individual tests Figure 1. The distribution of total serum immunoglobulin (Ig) G concentrations ( a ) and serum IgG4 concentrations ( b ) in 82 patients with autoimmune pancreatitis (AIP) and 110 patients with pancreatic cancer.

Conclusion The combined measurement of total serum IgG and IgG4 may increase diagnostic sensitivity without sacrificing specificity, compared with IgG4 alone. The measurement of ANA or RF may show no additional benefit when combined with total serum IgG and IgG4.