title: A proposal of a diagnostic algorithm with validation of International Consensus Diagnostic Criteria for autoimmune pancreatitis in a Japanese cohort.
abstract: BACKGROUND
  Among many diagnostic criteria for autoimmune pancreatitis (AIP), the International Consensus Diagnostic Criteria (ICDC) first enabled us to diagnose and compare type 1 and type 2 AIP, which permitted tailoring individual diagnostic algorithms depending on local expertise. We compared them and validated ICDC with special reference to levels 1 and 2, and proposed a diagnostic algorithm for AIP in Japan.
  
  
  METHODS
  The diagnostic sensitivity of 5 major criteria (ICDC, Korean, Japanese-2011, Asian, and HISORt criteria) was compared, using 61 patients with AIP. Fifty six patients with pancreatic cancer served as a control. Pancreas imaging on computed tomography (CT) and endoscopic retrograde pancreatography (ERP) were independently evaluated by 3 pancreatologists (5, 10, and 20 years of career experience) and each diagnostic criterion of ICDC was validated with special reference to levels 1 and 2.
  
  
  RESULTS
  The sensitivities of 5 major criteria were 95.1% (ICDC), 90.2% (Korean), 86.9% (Japanese), 83.6% (Asian), and 83.6% (HISORt) with 100% of specificity in each. In the evaluation of pancreas imaging, diagnostic sensitivities of combination with CT and ERP in segmental/focal type AIP were significantly higher than single imaging (26% in CT (P < 0.01) or 35% in ERP (P < 0.05) vs 63% in CT + ERP), but not significantly different in the diffuse type.
  
  
  CONCLUSIONS
  Of the 5 criteria, ICDC is the most sensitive and useful for diagnosing AIP. We have proposed a diagnostic algorithm with CT for the diffuse type of AIP, and combination with CT + ERP followed by EUS-FNA for the segmental/focal type.
authors.affiliation: Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, 10-15 Fumizono, Moriguchi, Osaka, Japan.
authors.forename: Kimi
authors.initials: K
authors.lastname: Sumimoto
authors.forename: Kazushige
authors.initials: K
authors.lastname: Uchida
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mitsuyama
authors.forename: Yuri
authors.initials: Y
authors.lastname: Fukui
authors.forename: Takeo
authors.initials: T
authors.lastname: Kusuda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Tomiyama
authors.forename: Norimasa
authors.initials: N
authors.lastname: Fukata
authors.forename: Masanori
authors.initials: M
authors.lastname: Koyabu
authors.forename: Yutaku
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ikeura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Shimatani
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Makoto
authors.initials: M
authors.lastname: Takaoka
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Nishio
authors.forename: Kazuichi
authors.initials: K
authors.lastname: Okazaki
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D044466:Asian People; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D032921:Consensus; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography