title: Utility of serum IgG, IgG4 and carbonic anhydrase II antibodies in distinguishing autoimmune pancreatitis from pancreatic cancer and chronic pancreatitis.
abstract: OBJECTIVE
  Autoimmune pancreatitis (AIP) can mimic pancreatic cancer in its clinical presentation, imaging features and laboratory parameters. The aim of our study was to compare IgG, IgG4 and anti-CAIIAb serum levels in patients with AIP, pancreatic adenocarcinoma (PA) and chronic pancreatitis (CP) and to assess their clinical significance and utility in differential diagnosis of pancreatic diseases.
  
  
  METHODS
  The study included 124 patients: 45 with PA, 24 with AIP and 55 with CP. Peripheral venous blood samples were obtained from all analyzed patients at the time of hospital admission and total IgG, IgG4 and anti-CAIIAB serum levels were measured using ELISA tests.
  
  
  RESULTS
  Serum levels of IgG, IgG4 and anti-CAIIAb were significantly higher in patients with AIP compared to PA and CP patients (p<0.001). In AIP patients the median IgG levels were 19.7 g/l, IgG4 levels - 301.9 mg/dl and anti-CAIIAb - 81.82 ng/ml, compared to 10.61 g/l, 123.2mg/dl and 28.6 ng/ml, respectively, in PA patients. IgG4 for the cut-off 210 mg/dl showed the best sensitivity and specificity (83.8% and 89.5%) in AIP diagnosis compared to IgG (69.3% and 87.3%, respectively) and anti-CAIIAb (45.3% and 74.3%). However, 16 (35.5%) patients with PA and 14 (25.4%) patients with CP had IgG4 levels greater than 140 mg/dl. Moreover, in 3 (6.67%) patients with pancreatic cancer those values were greater than 280 mg/dl. No patients with CP had IgG4 more than 280 mg/dl.
  
  
  CONCLUSIONS
  IgG4 at cut-off 210 mg/dl showed the best sensitivity and specificity in AIP diagnosis compared to IgG and anti-CAIIAb, however elevations of serum IgG4 may be seen in subjects without AIP, including pancreatic cancer.
authors.affiliation: Department of Digestive Tract Diseases, Medical University of Lodz, Poland. Electronic address: r-wojnarowska@wp.pl.
authors.forename: Renata
authors.initials: R
authors.lastname: Talar-Wojnarowska
authors.affiliation: Department of Digestive Tract Diseases, Medical University of Lodz, Poland.
authors.forename: Anita
authors.initials: A
authors.lastname: Gąsiorowska
authors.affiliation: Department of Digestive Tract Surgery, Silesian Medical University, Katowice, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Olakowski
authors.affiliation: Department of Digestive Tract Surgery, Silesian Medical University, Katowice, Poland.
authors.forename: Daria
authors.initials: D
authors.lastname: Dranka-Bojarowska
authors.affiliation: Department of Digestive Tract Surgery, Silesian Medical University, Katowice, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Lampe
authors.affiliation: Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Śmigielski
authors.affiliation: Department of Microbiology and Laboratory Medical Immunology, Faculty of Medicine, Medical University of Lodz, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kujawiak
authors.affiliation: Department of Microbiology and Laboratory Medical Immunology, Faculty of Medicine, Medical University of Lodz, Poland.
authors.forename: Janina
authors.initials: J
authors.lastname: Grzegorczyk
authors.affiliation: Department of Digestive Tract Diseases, Medical University of Lodz, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Małecka-Panas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000032:analysis*; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D024402:Carbonic Anhydrase II / Q000037:antagonists & inhibitors*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D050500:Pancreatitis, Chronic / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D011044:Poland; D012680:Sensitivity and Specificity; D015854:Up-Regulation
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D007074:Immunoglobulin G; D024402:Carbonic Anhydrase II
keywords: Autoimmune pancreatitis; Carbonic anhydrase II (CAII); Chronic pancreatitis; IgG; IgG4; Pancreatic adenocarcinoma