title: Is pancreatic core biopsy sufficient to diagnose autoimmune chronic pancreatitis?
abstract: OBJECTIVE
  This study aimed to evaluate the adequacy of pancreatic core biopsy in histological diagnosis of autoimmune chronic pancreatitis (AIP).
  
  
  METHODS
  Histopathologic study as well as immunohistochemical staining using anti-IgG4 antibody was done with pancreatic tissue specimens of 26 AIP patients (19 transabdominal ultrasound (US)-guided core biopsies, 3 intraoperative wedge biopsies, and 4 surgical resections). Eight patients with alcoholic chronic pancreatitis and 10 patients with pancreatic cancer served as controls.
  
  
  RESULTS
  Lymphoplasmacytic sclerosing pancreatitis (LPSP) histology was observed in 26% (5/19) of US-guided core biopsy specimens, 33% (1/3) of open biopsy specimens, and all 4 resection specimens in AIP patients. None of the patients in the control group showed the full spectrum of changes of LPSP. Abundant IgG4-positive cells (>10 cells/high-power field) in the pancreas were observed in 21% (4/19) of AIP patients with US-guided core biopsy specimen. Abundant IgG4-positive cells in the pancreas were also observed in 2 of 8 patients with chronic alcoholic pancreatitis and 1 of 10 patients with pancreatic cancer.
  
  
  CONCLUSIONS
  Transabdominal US-guided pancreatic core biopsy may not provide enough tissue to evaluate characteristic histopathologic features of AIP that include LPSP or abundant IgG4-positive cell infiltration. The LPSP histology may be specific to AIP, but abundant IgG4-positive cells in the pancreas may not.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Sung-Jo
authors.initials: SJ
authors.lastname: Bang
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Do Ha
authors.initials: DH
authors.lastname: Kim
authors.forename: Tae Yoon
authors.initials: TY
authors.lastname: Lee
authors.forename: Seunghyun
authors.initials: S
authors.lastname: Kwon
authors.forename: Hyoung-Chul
authors.initials: HC
authors.lastname: Oh
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Chang Yun
authors.initials: CY
authors.lastname: Hwang
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Song
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
mesh_terms: D000368:Aged; D001327:Autoimmune Diseases / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D019512:Pancreatitis, Alcoholic / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000276:immunology* / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D007074:Immunoglobulin G