title: Comparison study of immunohistochemical staining for the diagnosis of type 1 autoimmune pancreatitis.
abstract: BACKGROUND
  Various methods to evaluate immunohistochemical staining (IHC) for the diagnosis of type 1 autoimmune pancreatitis (AIP) have been proposed. Our goal was to determine the most useful IHC method for the diagnosis of AIP.
  
  
  METHODS
  Specimens of AIP (18 patients), chronic pancreatitis (CP, 24 patients), and pancreatic ductal adenocarcinoma (PDA, 45 patients) were evaluated with IHC for immunoglobulin G (IgG), IgG1, IgG4, and CD138 (syndecan-1). The number of IHC-positive cells was counted in 3, 5, and 10 different high-power fields (HPFs) by selecting fields with the most numerous positive cells (hotspot) or by randomly selecting fields in the affected areas (random). We evaluated the mean number of IgG4-positive plasma cells (IgG4+)/HPF (mean IgG4+), the number of fields with >10 and >50 IgG4+ (NOF >10 and NOF >50 IgG4+), the ratio of IgG4+/IgG+, IgG4+/IgG1+, and IgG4+/CD138+.
  
  
  RESULTS
  Analysis with receiver operator characteristic curves revealed that accurate and practical parameters in 3 HPFs were mean IgG4+ with the hotspot method (sensitivity, 88.9; specificity, 92.8 %), mean IgG4+ with the random method (100, 95.7 %), and NOF >10 IgG4+ with the random method (94.4, 97.1 %). These results were as accurate as results from 5 HPFs to 10 HPFs. The combination of mean IgG4+ and IgG4+/IgG+ did not provide more accurate diagnosis for AIP than a single criterion itself.
  
  
  CONCLUSIONS
  Mean IgG4+ or NOF >10 IgG4+ with the random method in 3 HPFs was a useful and simple diagnostic method for AIP. The combined criteria of mean IgG4+ and IgG4+/IgG+ might not be required for accurate diagnosis of AIP.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan, kmiyabe@med.nagoya-cu.ac.jp.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Kenji
authors.initials: K
authors.lastname: Notohara
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000175:diagnosis*; D015415:Biomarkers / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D050500:Pancreatitis, Chronic / Q000175:diagnosis*; D010950:Plasma Cells / Q000276:immunology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G
references.citation: Am J Gastroenterol. 2009 Sep;104(9):2288-94
references.pmid: 19568232
references.citation: J Clin Pathol. 2008 Oct;61(10):1093-7
references.pmid: 18682417
references.citation: J Gastroenterol. 2014 Apr;49(4):715-26
references.pmid: 23645070
references.citation: Virchows Arch. 2009 May;454(5):531-9
references.pmid: 19238431
references.citation: Pancreas. 2011 Apr;40(3):352-8
references.pmid: 21412117
references.citation: Am J Surg Pathol. 2007 Apr;31(4):521-8
references.pmid: 17414098
references.citation: J Clin Pathol. 2011 Mar;64(3):237-43
references.pmid: 21233087
references.citation: Pancreas. 1997 Apr;14(3):215-21
references.pmid: 9094150
references.citation: Int J Rheumatol. 2012;2012:609795
references.pmid: 22899937
references.citation: Am J Surg Pathol. 2009 Sep;33(9):1330-40
references.pmid: 19718789
references.citation: Clin Gastroenterol Hepatol. 2012 Jan;10(1):91-4
references.pmid: 21946123
references.citation: Dig Endosc. 2014 Sep;26(5):627-35
references.pmid: 24712522
references.citation: J Gastroenterol. 2003;38(4):315-26
references.pmid: 12743770
references.citation: Am J Surg Pathol. 2010 Dec;34(12):1812-9
references.pmid: 21107087
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1646-53
references.pmid: 17555461
references.citation: Cancer. 1950 Jan;3(1):32-5
references.pmid: 15405679
references.citation: Am J Surg Pathol. 2008 Jul;32(7):986-95
references.pmid: 18460977
references.citation: Am J Surg Pathol. 2008 Dec;32(12):1770-9
references.pmid: 18779730
references.citation: J Gastroenterol. 2010 Jul;45(7):732-41
references.pmid: 20087609
references.citation: Endoscopy. 2004 May;36(5):397-401
references.pmid: 15100946
references.citation: Am J Surg Pathol. 2008 May;32(5):671-81
references.pmid: 18344866
references.citation: J Gastroenterol. 2006 Jul;41(7):626-31
references.pmid: 16932998
references.citation: Hum Pathol. 2005 Jul;36(7):710-7
references.pmid: 16084938
references.citation: Mod Pathol. 2012 Sep;25(9):1181-92
references.pmid: 22596100
references.citation: J Gastroenterol. 2007 May;42 Suppl 18:6-8
references.pmid: 17520216
references.citation: Clin Gastroenterol Hepatol. 2012 Mar;10(3):316-22
references.pmid: 22019795
references.citation: Mod Pathol. 2007 Jan;20(1):23-8
references.pmid: 16980948
references.citation: Am J Surg Pathol. 2006 Dec;30(12):1537-45
references.pmid: 17122509
references.citation: Gastrointest Endosc. 2012 Sep;76(3):594-602
references.pmid: 22898417
references.citation: Gastroenterology. 2008 Mar;134(3):706-15
references.pmid: 18222442
references.citation: Gastrointest Endosc. 2002 Oct;56(4 Suppl):S86-91
references.pmid: 12297756
references.citation: Clin Gastroenterol Hepatol. 2009 Oct;7(10):1097-103
references.pmid: 19410017
references.citation: Gut. 1984 Jul;25(7):756-9
references.pmid: 6735257
references.citation: Mod Rheumatol. 2012 Feb;22(1):21-30
references.pmid: 22218969
references.citation: Int J Rheumatol. 2012;2012:259408
references.pmid: 22611406
references.citation: Hum Pathol. 2010 May;41(5):643-52
references.pmid: 20149413
references.citation: Am J Gastroenterol. 2009 Sep;104(9):2295-306
references.pmid: 19532132
references.citation: Am J Surg Pathol. 2005 Jun;29(6):783-91
references.pmid: 15897744
references.citation: Dig Liver Dis. 2011 Nov;43(11):869-74
references.pmid: 21733766
references.citation: Biom J. 2005 Aug;47(4):458-72
references.pmid: 16161804
references.citation: J Gastroenterol. 2003;38(10):982-4
references.pmid: 14614606
references.citation: N Engl J Med. 2012 Feb 9;366(6):539-51
references.pmid: 22316447
references.citation: Pancreas. 2008 Jan;36(1):84-9
references.pmid: 18192887
references.citation: Clin Gastroenterol Hepatol. 2007 Oct;5(10):1229-34
references.pmid: 17702660
references.citation: Cancer Causes Control. 2006 May;17(4):403-9
references.pmid: 16596292
references.citation: J Gastroenterol. 2009;44(7):742-50
references.pmid: 19434362
references.citation: J Gastroenterol Hepatol. 2004 Sep;19(9):998-1004
references.pmid: 15304116