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DOI: 10.1055/a-1236-3266
Utility of endoscopic ultrasound-guided fine-needle biopsy in the diagnosis of type 1 autoimmune pancreatitis[*]
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Abstract
Background and study aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) performs poorly in the histological diagnosis of type 1 autoimmune pancreatitis (AIP). The aim of this study was to assess the performance of fine-needle biopsy (FNB) comparing reverse bevel (RB) and fork-tip (FT) needles.
Patients and methods A retrospective study of prospectively maintained databases was performed. Patients with a final diagnosis of type 1 AIP who underwent EUS-FNB during diagnostic workup were included. Pathology reports were reviewed and classified as per international consensus diagnostic criteria (ICDC). The Primary outcome was EUS-FNB sensitivity in diagnosing type 1 AIP.
Results Between March 2011 and December 2018, 24 patients with a final diagnosis of type 1 AIP underwent FNB. Six patients underwent biopsy with the RB needle and 18 with the FT needle. Mean age (± SD) 62.2 (± 11.4), 17 (70.8 %) male. No RB samples were diagnostic compared to 14 (78 %) FT; P = 0.001; of which 13 (72 %) were level 1. In eight (44 %) of FT cases a diagnosis was not possible without histology. Initial biopsy was diagnostic in five (62.5 %) of these cases. Including repeat biopsy, seven (87 %) had a diagnosis made by FT needle. Obliterative phlebitis (44 %) was the least frequently identified pathological feature and immunoglobulin (IgG)4 + plasma cells > 10 per high power field (78 %) the most common.
Conclusion The FT needle demonstrated good performance for diagnosing type 1 AIP. The results support the preferential use of this core biopsy needle for EUS pancreatic tissue sampling.
* Meeting presentations: Pancreatic Society of Great Britain and Ireland November 2018, Digestive Disease Week May 2019, and British Society of Gastroenterology annual meeting June 2019
Publikationsverlauf
Eingereicht: 28. Mai 2010
Angenommen: 23. Juli 2020
Artikel online veröffentlicht:
27. November 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Shimosegawa T, Chari ST, Frulloni L. et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011; 40: 352-328
- 2 Chari ST, Smyrk TC, Levy MJ. et al. Diagnosis of autoimmune pancreatitis: The Mayo Clinic Experience. Clin Gastroenterol Hepatol 2006; 4: 1010-1016
- 3 Arora K, Rivera M, Ting DT. et al. The histological diagnosis of IgG4‐related disease on small biopsies: challenges and pitfalls. Histopathology 2019; 74: 688-698
- 4 Detlefsen S, Kloppel G. IgG4-related disease: with emphasis on the biopsy diagnosis of autoimmune pancreatitis and sclerosing cholangitis. Virchows Arch 2018; 472: 545-556
- 5 Deshpande V, Zen Y, Chan JKC. et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol 2012; 25: 1181-1192
- 6 Puli SR, Bechtold ML, Buxbaum JL. et al. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass? A meta-analysis and systematic review. Pancreas 2013; 42: 20-26
- 7 Morishima T, Kawashima H, Ohno E. et al. Prospective multicenter study on the usefulness of EUS-guided FNA biopsy for the diagnosis of autoimmune pancreatitis. Gastrointest Endosc 2016; 84: 241-248
- 8 Majumder S, Chari ST. EUS-guided FNA for diagnosing autoimmune pancreatitis: Does it enhance existing consensus criteria?. Gastrointest Endosc 2016; 84: 805-807
- 9 Nagpal SJS, Sharma A, Chari ST. Autoimmune Pancreatitis. Am J Gastroenterol 2018; 113: 1301
- 10 Bang JY, Krall K, Jhala N. et al. Comparing needles and methods of endoscopic ultrasound-guided fine-needle biopsy to optimize specimen quality and diagnostic accuracy for patients with pancreatic masses in a randomized trial. Clin Gastroenterol Hepatol 2020; DOI: 10.1016/j.cgh.2020.06.042.
- 11 Gardner TB, Levy MJ, Takahashi N. et al. Misdiagnosis of autoimmune pancreatitis: a caution to clinicians. Am J Gastroenterol 2009; 104: 1620-1623
- 12 Dickerson LD, Farooq A, Bano F. et al. Differentiation of Autoimmune pancreatitis from pancreatic cancer remains challenging. World J Surg 2019; 43: 1604-1611
- 13 van Heerde MJ, Biermann K, Zondervan PE. et al. Prevalence of autoimmune pancreatitis and other benign disorders in pancreatoduodenectomy for presumed malignancy of the pancreatic head. Dig Dis Sci 2012; 57: 2458-2465
- 14 Iwashita T, Yasuda I, Doi S. et al. Use of samples from endoscopic ultrasound-guided 19-gauge fine-needle aspiration in diagnosis of autoimmune pancreatitis. Clin Gastroenterol Hepatol 2012; 10: 316-322
- 15 Kanno A, Masamune A, Fujishima F. et al. Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study. Gastrointest Endosc 2016; 84: 797-804.e1
- 16 Cao L, Wang Y, Wang J. et al. The role of EUS-guided fine-needle aspiration in autoimmune pancreatitis: a single center prospective study. Scand J Gastroenterol 2018; 53: 1604-1610
- 17 Mizuno N, Bhatia V, Hosoda W. et al. Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: A comparison study with EUS-FNA. J Gastroenterol 2009; 44: 742-750
- 18 Levy MJ, Smyrk TC, Takahashi N. et al. Idiopathic duct-centric pancreatitis: Disease description and endoscopic ultrasonography-guided trucut biopsy diagnosis. Pancreatology 2011; 11: 76-80
- 19 Levy MJ, Reddy RP, Wiersema MJ. et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc 2005; 61: 467-472
- 20 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48: 339-349
- 21 Khan MA, Grimm IS, Ali B. et al. A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment. Endosc Int Open 2017; 5: E363-E375
- 22 Oppong KW, Bekkali NLH, Leeds JS. et al. FT needle biopsy versus fine-needle aspiration in endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized crossover study. Endoscopy 2020; DOI: 10.1055/a-1114-5903.
- 23 Bhattacharya A, Cruise M, Chahal P. Endoscopic ultrasound guided 22 gauge core needle biopsy for the diagnosis of autoimmune pancreatitis. Pancreatology 2018; 18: 168-169
- 24 Runge TM, Hart PA, Sasatomi E. et al. Diagnosis of autoimmune pancreatitis using new, flexible EUS core biopsy needles: report of two cases. Gastrointest Endosc 2017; 85: 1311-1312
- 25 Detlefsen S, Joergensen MT, Mortensen MB. Microscopic findings in EUS-guided fine-needle (SharkCore) biopsies with type 1 and type 2 autoimmune pancreatitis. Pathol Int 2017; 67: 514-520
- 26 Kurita A, Yasukawa S, Zen Y. et al. Comparison of a 22-gauge Franseen-tip needle with a 20-gauge forward-bevel needle for the diagnosis of type 1 autoimmune pancreatitis: a prospective, randomized, controlled, multicenter study (COMPAS study). Gastrointest Endosc 2020; 91: 373-381