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EUS-FNA with larger-gauge needle useful for diagnosing autoimmune pancreatitis
Endoscopic ultrasound-guided fine needle aspiration with a 22-gauge needle may be useful for histopathologic diagnosis of autoimmune pancreatitis, according to results from a prospective study.
EUS-FNA is not included in the 2011 International Consensus Diagnostic Criteria “as a method for histopathologic diagnosis of [autoimmune pancreatitis] because of the difficulty in obtaining adequate specimens for histopathologic analysis,” researchers wrote. “However, several reports have suggested that EUS-FNA is useful for the diagnosis of AIP.”
Therefore, to determine the utility of EUS-FNA using a 22-gauge needle for diagnosing AIP, investigators performed a prospective study of 78 patients with suspected AIP who underwent the procedure at 12 tertiary care referral centers in Japan between February 2013 and March 2014. EUS-FNA was performed using an Expect 22-gauge needle (Boston Scientific).
The investigators collected tissue specimens and a blinded pathologist evaluated them for sampling conditions, CD38- and IgG4-positive plasma cell counts, storiform fibrosis and obliterative phlebitis.
Sixty-two patients had tissue samples with at least one high-power field, with a mean IgG4-positive plasma cell count of 5.1/HPF, a mean CD38-positive plasma cell count of 23.2/HPF, a 62.8% rate of storiform fibrosis and a 48.7% rate of obliterative phlebitis.
Ultimately, 45 of the patients had features that indicated a diagnosis of AIP, and thus 58% of the total cohort could be diagnosed with lymphoplasmacytic sclerosing pancreatitis per ICDC guidelines. No adverse events occurred during or after the procedure.
“In agreement with our previous study, pancreatic tissues with at least 1 HPF were obtained from approximately 80% of patients by EUS-FNA with a 22[-gauge] needle,” the researchers concluded. “Nearly 60% of patients were diagnosed with ICDC level 2 or higher, supporting the notion that EUS-FNA with a 22[-gauge] needle is useful for the histopathologic diagnosis of AIP.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.